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Lin X, Chen Z, Zhao Q, Zhou X. Benefit-finding profiles and comparison of caregiving ability among informal caregivers of patients with lung cancer: A latent profile analysis. Asia Pac J Oncol Nurs 2024; 11:100480. [PMID: 38779178 PMCID: PMC11109306 DOI: 10.1016/j.apjon.2024.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/24/2024] [Indexed: 05/25/2024] Open
Abstract
Objective This study aimed to explore the benefit finding (BF) profiles among informal caregivers of patients with lung cancer, identify demographic and disease characteristics, and analyze differences in caregiving ability between profiles. Methods This cross-sectional study utilized convenience sampling to select 272 informal caregivers of patients with lung cancer from a tertiary care hospital in Guangzhou, China. The research instruments used included the Demographic and Disease Characteristics Questionnaire, the revised version of the BF Scale, and the Chinese version of the Family Caregiver Task Inventory. Data analysis was performed using latent profile analysis, chi-square test, Fisher's exact probability test, Kruskal-Wallis test, and multivariate logistic regression. Results (1) BF can be divided into three profiles: "high benefit-family and personal growth" (Profile 1, 7.7%), "moderate benefit-unclear perception" (Profile 2, 44.9%), and "low benefit-coping ability deficient" (Profile 3, 47.4%). (2) Having a cocaregiver and a disease duration of 6-12 months were more likely to belong to Profile 1; caregivers of patients aged 40-60 years tended to belong to Profile 2; caregivers of older patients with disease duration > 12 months and clinical stage II or III were more likely to belong to Profile 3. (3) There were significant differences in the total score of caregiving ability and the scores of each dimension among the different BF profiles (P < 0.001), and the caregiving abilities of Profile 1 and Profile 2 were higher than those of Profile 3. Conclusions There was heterogeneity in BF among informal caregivers of patients with lung cancer. Healthcare professionals can identify the key profiles of lung-cancer caregivers based on characteristics such as age, clinical stage, disease duration, and cocaregiver status and enhance their caregiving ability through targeted nursing guidance.
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Affiliation(s)
- Xiaoyuan Lin
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ziqing Chen
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Qi Zhao
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaozhou Zhou
- Department of Nursing, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
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Dyball D, Bennett AN, Schofield S, Cullinan P, Boos CJ, Bull AM, Stevelink SA, Fear NT. The underlying mechanisms by which Post-Traumatic Growth is associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study. J Health Psychol 2024:13591053241240196. [PMID: 38605584 DOI: 10.1177/13591053241240196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Post-Traumatic Growth (PTG) is associated with good cardiovascular health, but the mechanisms of this are poorly understood. This cross-sectional analysis assessed whether factors of PTG (Appreciation of Life (AOL), New Possibilities (NP), Personal Strength (PS), Relating to Others (RTO) and Spiritual Change (SC)) are associated with cardiovascular health in a cohort of 1006 male UK military personnel (median age 34). The findings suggest AOL, PS and RTO are associated with better cardiovascular health through cardiometabolic effects (lower levels of triglycerides, and total cholesterol) and haemodynamic functioning (lower diastolic blood pressure), but not inflammation. However, NP and SC were associated with poorer cardiovascular health through cardiometabolic effects (lower levels of high-density lipoproteins and higher levels of total cholesterol) and AOL had a non-linear association with low-density lipoproteins. These findings suggest that the relationship between PTG and cardiovascular functioning is complex and in need of further scrutiny.
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Low NJH, Leow DGW, Klainin-Yobas P. Effectiveness of Technology-Based Psychosocial Interventions on Psychological Outcomes Among Adult Cancer Patients and Caregivers: A Systematic Review and Meta-Analysis. Semin Oncol Nurs 2024; 40:151533. [PMID: 37977974 DOI: 10.1016/j.soncn.2023.151533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Technology-based psychosocial interventions (TBPIs) have increasingly gained intention. However, the effectiveness of TBPIs on psychological outcomes remains inconclusive. This review aimed to evaluate the effectiveness of TBPIs on health-related quality of life (HRQOL), coping, self-efficacy, and depression among adult cancer patients and caregivers. DATA SOURCES Randomised controlled trials (RCTs) evaluating the effectiveness of TBPIs targeting adult cancer patients, caregivers, or patient-caregiver dyads were included. English articles dated from 2012 to 2022 were retrieved from eight electronic databases, three clinical trial registries, and six grey literature databases. Two reviewers independently screened, appraised, and extracted data. The Cochrane risk of bias assessment tool and GRADE were used to appraise the methodological quality of included studies. Meta-analyses and subgroup analyses were undertaken with statistical pooling of standardized mean differences based on the random-effects model. CONCLUSION Totally, 37 RCTs were included in the review, with 35 trials for meta-analysis. Results demonstrated improvements in HRQOL, self-efficacy, and depression among cancer patients and caregivers with varying pooled effect sizes. Subgroup analyses suggested that dyadic TBPIs were more effective in improving HRQOL among cancer patients and caregivers, compared with those solely targeted at cancer patients or caregivers. IMPLICATION FOR NURSING PRACTICE Findings value-added to the existing evidence base on TBPIs. An interactive patient-caregiver dyadic program integrating TBPIs into routine oncology care is recommended to improve health outcomes for cancer patients and caregivers. Well-designed future RCTs are required to further evaluate the effectiveness of dyadic TBPIs, with emphasis on coping and self-efficacy outcomes among cancer patients and caregivers.
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Affiliation(s)
| | - Darryl Ge Wei Leow
- Staff Nurse, Woodlands Health Campus, Yishun Community Hospital, Singapore
| | - Piyanee Klainin-Yobas
- Associate Professor, Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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Özönder Ünal I, Ordu C. Decoding Caregiver Burden in Cancer: Role of Emotional Health, Rumination, and Coping Mechanisms. Healthcare (Basel) 2023; 11:2700. [PMID: 37830736 PMCID: PMC10573024 DOI: 10.3390/healthcare11192700] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
This study aimed to elucidate the role of psychological factors in caregiver burden among caregivers of stage 4 cancer patients. Data were collected from 328 caregivers of cancer patients, employing the Zarit Care Burden Scale, Depression-Anxiety-Stress Scale (DASS-42), Dysfunctional Attitudes Scale (DAS-A), Ruminative Thought Style Questionnaire (RTSQ), and Coping Orientation to Problems Experienced Inventory (Brief COPE). Males, spouses, and caregivers of patients with a PEG or tracheostomy, or those diagnosed with pancreatic biliary cancer were found to have a significantly higher risk of caregiver burden. Age, sex, caregiver-patient relationship, caregiving duration, patient's catheter status, cancer types, depression and stress severity, rumination, dysfunctional attitudes, and dysfunctional coping strategies explained 69.7% of the variance in Zarit Care Burden Scale scores (F(14,313) = 51.457, p < 0.001), illustrating their significant predictive relationship with caregiver burden. Moderation analysis revealed significant interactions of emotional coping with depression (b = -0.0524, p = 0.0076) and dysfunctional coping with stress on caregiver burden (b = 0.014, p = 0.006). Furthermore, rumination mediated the relationships between caregiver burden, stress, and depression (p < 0.01). Overall, the results highlight the intricate relationships among caregiver burden, mental health, and coping strategies, suggesting tailored interventions to support caregiver health and quality of care.
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Affiliation(s)
- Ipek Özönder Ünal
- Department of Psychiatry, Tuzla State Hospital, Içmeler Mahallesi, Piri Reis Caddesi, No: 74 Tuzla, Istanbul 34947, Turkey
| | - Cetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, Cemil Aslan Güder Sk. No: 8, Beşiktaş, Istanbul 34349, Turkey;
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Chen X, Qiao C, Arber A, Shen Y, Rui Y, Zhang R, Pei Z, Tang Y, Sha Z, Bao J, Zhang J, Li J, Wang D, Wang X. Enhancing resilient coping strategies for quality of life in Chinese adult children caregiving for parents with advanced cancer: a cross-sectional study. Support Care Cancer 2023; 31:591. [PMID: 37749433 PMCID: PMC10520155 DOI: 10.1007/s00520-023-08057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE This study investigated the mediating role of individual resilience in the relationship between caregiver burden and quality of life (QoL) among Chinese adult children providing care to their parents with advanced cancer, with the aim to inform effective coping strategies and positive caregiving outcomes. METHODS In a cross-sectional design, 614 caregivers from multiple centers, whose parents were undergoing chemotherapy and/or radiotherapy, completed questionnaires encompassing demographics, caregiver burden, symptoms of anxiety and depression, resilience, and QoL. RESULTS Findings revealed a moderate level of caregiver burden among participants, significantly influenced by factors including education level, family income, single-child status, and participation in social media patient support groups. Caregivers who were only children or involved in patient support groups reported higher burden. Importantly, path analysis showed a significant impact of caregiver burden, anxiety, and depression on QoL, with these relationships being mediated by individual resilience. CONCLUSIONS Chinese adult child caregivers face a considerable burden, negatively influencing their QoL. Individual resilience, a modifiable factor, was identified as a critical mediator in this relationship, mitigating the negative implications of caregiver burden, anxiety, and depression. These findings underscore the need for caregiver interventions that consider not only demographics but also the socio-psychological dynamics of caregiving to enhance caregiver QoL.
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Affiliation(s)
- Xian Chen
- Gynaecology Department, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, People's Republic of China
| | - Chengping Qiao
- Gynaecology Department, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, People's Republic of China
| | - Anne Arber
- School of Health Sciences, Faculty of Health and Medical Sciences, The University of Surrey, Guildford, UK
| | - Yan Shen
- Interventional Radiology Department, The First Affiliated Hospital With Nanjing Medical University, Nanjing, People's Republic of China
| | - Yehao Rui
- Oncology Department, Zhongda Hospital Southeast University, Nanjing, People's Republic of China
| | - Rui Zhang
- Oncology Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Zhongling Pei
- Interventional Radiology Department, The First Affiliated Hospital With Nanjing Medical University, Nanjing, People's Republic of China
| | - Yuanyuan Tang
- Radiotherapy Department, The First Affiliated Hospital With Nanjing Medical University, Nanjing, People's Republic of China
| | - Ziyu Sha
- Oncology Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Jianying Bao
- Interventional Radiology Department, The First Affiliated Hospital With Nanjing Medical University, Nanjing, People's Republic of China
| | - Jia Zhang
- Oncology Department, The First Affiliated Hospital With Nanjing Medical University, Nanjing, People's Republic of China
| | - Jinhua Li
- Geriatric Oncology Department, The First Affiliated Hospital With Nanjing Medical University, Nanjing, People's Republic of China
| | - Dan Wang
- Oncology Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.
| | - Xuemei Wang
- Interventional Radiology Department, The First Affiliated Hospital With Nanjing Medical University, Nanjing, People's Republic of China.
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Chow R, Mathews JJ, Cheng EY, Lo S, Wong J, Alam S, Hannon B, Rodin G, Nissim R, Hales S, Kavalieratos D, Quinn KL, Tomlinson G, Zimmermann C. Interventions to improve outcomes for caregivers of patients with advanced cancer: a meta-analysis. J Natl Cancer Inst 2023; 115:896-908. [PMID: 37279594 PMCID: PMC10407714 DOI: 10.1093/jnci/djad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/04/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Family caregivers of patients with advanced cancer often have poor quality of life (QOL) and mental health. We examined the effectiveness of interventions offering support for caregivers of patients with advanced cancer on caregiver QOL and mental health outcomes. METHODS We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and Cumulative Index to Nursing and Allied Health Literature databases from inception through June 2021. Eligible studies reported on randomized controlled trials for adult caregivers of adult patients with advanced cancer. Meta-analysis was conducted for primary outcomes of QOL, physical well-being, mental well-being, anxiety, and depression, from baseline to follow-up of 1-3 months; secondary endpoints were these outcomes at 4-6 months and additional caregiver burden, self-efficacy, family functioning, and bereavement outcomes. Random effects models were used to generate summary standardized mean differences (SMD). RESULTS Of 12 193 references identified, 56 articles reporting on 49 trials involving 8554 caregivers were eligible for analysis; 16 (33%) targeted caregivers, 19 (39%) patient-caregiver dyads, and 14 (29%) patients and their families. At 1- to 3-month follow-up, interventions had a statistically significant effect on overall QOL (SMD = 0.24, 95% confidence interval [CI] = 0.10 to 0.39); I2 = 52.0%), mental well-being (SMD = 0.14, 95% CI = 0.02 to 0.25; I2 = 0.0%), anxiety (SMD = 0.27, 95% CI = 0.06 to 0.49; I2 = 74.0%), and depression (SMD = 0.34, 95% CI = 0.16 to 0.52; I2 = 64.4) compared with standard care. In narrative synthesis, interventions demonstrated improvements in caregiver self-efficacy and grief. CONCLUSIONS Interventions targeting caregivers, dyads, or patients and families led to improvements in caregiver QOL and mental health. These data support the routine provision of interventions to improve well-being in caregivers of patients with advanced cancer.
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Affiliation(s)
- Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jean J Mathews
- Division of Palliative Medicine, Department of Medicine and Department of Oncology, Queen’s University, Kingston, ON, Canada
| | - Emily YiQin Cheng
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samantha Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joanne Wong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sorayya Alam
- Palliative Medicine, Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - Kieran L Quinn
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine and Palliative Care, Department of Medicine, Sinai Health System, Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | - George Tomlinson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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von Heymann A, Finsted E, Guldin MB, Andersen EAW, Dammeyer J, Sjøgren P, von der Maase H, Benthien KS, Kjellberg J, Johansen C, Bidstrup P. Effects of home-based specialized palliative care and dyadic psychological intervention on caregiver burden: results from a randomized controlled trial. Acta Oncol 2023; 62:803-807. [PMID: 37010505 DOI: 10.1080/0284186x.2023.2194491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/18/2023] [Indexed: 04/04/2023]
Abstract
Background The Domus study, a randomized controlled trial (RCT), evaluated the effect of home-based specialized palliative care (SPC) reinforced with a psychological intervention for the patient-caregiver dyad on increasing advanced cancer patients' time spent at home, as opposed to hospitalized, and the number of home deaths. As palliative care extends to include support for patients' families and may thus assist caregivers and decrease demands on them, in this study we evaluated a secondary outcome, caregiver burden.Material and Methods Patients with incurable cancer and their caregivers were randomized (1:1) to care as usual or home-based SPC. Caregiver burden was assessed using the Zarit Burden Interview (ZBI) at baseline and 2, 4, 8 weeks and 6 months after randomization. Intervention effects were assessed in mixed effects models.Results A total of 258 caregivers were enrolled. Eleven per cent of informal caregivers experienced severe caregiver burden at baseline. Caregiver burden increased significantly over time in both groups (p = 0.0003), but no significant effect of the intervention was seen on overall caregiver burden (p = 0.5046) or burden subscales measuring role and personal strain.Conclusion In line with the majority of previous RCTs, the Domus intervention was not able to significantly reduce caregiver burden. Future interventions should consider targeting only caregivers reporting the greatest caregiver burden.
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Affiliation(s)
- Annika von Heymann
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emma Finsted
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Public Health, Aarhus University, Aarhus, Denmark
| | | | - Jesper Dammeyer
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Per Sjøgren
- Palliative Research Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans von der Maase
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirstine S Benthien
- Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Denmark
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE, The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pernille Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Kim Y, Lin J, Epel ES, Carver CS. A Lens on Caregiver Stress in Cancer: Longitudinal Investigation of Cancer-Related Stress and Telomere Length Among Family Caregivers of Adult Patients With Cancer. Psychosom Med 2023; 85:527-534. [PMID: 37260287 PMCID: PMC10524877 DOI: 10.1097/psy.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Family members are typically the primary caregivers of patients with chronic illnesses. Family caregivers of adult relatives with cancer are a fast-growing population, yet the physical consequences of their stress due to the cancer in the family have been poorly understood. This study examined the bidirectional relations of the perceived stress of family caregivers of individuals recently diagnosed with cancer and leukocyte cellular aging indexed by telomere length for 2 years. METHODS Family caregivers ( N = 168; mean age = 51 years, 70% female, 46% Hispanic, 36% spouse to the patient) of patients with colorectal cancer provided psychological data and peripheral blood samples approximately 4 (T1), 12 (T2), and 21 months (T3) after diagnosis. Time-lagged cross-panel modeling was used to test the associations of perceived cancer-related stress and telomere length, controlling for age, sex, and body mass index. RESULTS Cancer-related stress was highest at T1 and decreased by 1 year. Greater cancer-related stress predicted longer telomere length at subsequent assessments for 2 years ( β ≥ 0.911, p ≤ .019). However, telomere length did not change significantly for 2 years overall and did not prospectively predict cancer-related stress over this period. CONCLUSIONS Findings suggest the need to better understand how the perceived stress of colorectal cancer caregivers, which tends to be intense for a relatively short period compared with dementia caregiving, may impact immune cell distributions and telomere length. These findings emphasize the need for further knowledge about psychobiological mechanisms of how cancer caregiving may impact cellular aging.
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Affiliation(s)
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco
| | - Elissa S. Epel
- Department of Psychiatry, University of California, San Francisco
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Hua LS, Chen YY, Yiin JJ, Lee KC. Caregiving burdens of family members of patients living with hepatocellular carcinoma. Int J Palliat Nurs 2023; 29:17-27. [PMID: 36692481 DOI: 10.12968/ijpn.2023.29.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Caregiving burden is common among family caregivers (FCs). In Taiwan, no reports have compared caregiving burden according to disease stage, or explored the comprehensive factors of caregiving burden in the FCs of patients with hepatocellular carcinoma (HCC). AIM The aim of the study was to investigate caregiving burden at different diagnosis stages and its potential predictors in the FCs of patients with hepatocellular carcinoma. METHODS This descriptive, cross-sectional study included 192 FCs. Caregiving burden was measured using the Caregiver Reaction Assessment tool. The predictive factors of caregiving burden in the FCs of patients with HCC were identified using a linear regression model. RESULTS The global caregiving burden had no significant differences between the four disease stages. The lack of family support and impact on schedule were significantly higher at the terminal stage than at the earlier stage. The risk factors of caregiving burden were high depression, high financial demand, heavy caregiving tasks, advanced age and frequent patient contact, which obtained a variance of 47.8% in the regression model. CONCLUSION Healthcare providers need to proactively identify and assess FCs with risk factors of caregiving burden and provide appropriate interventions specific to individual needs at different disease stages.
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Affiliation(s)
- Lu-Shu Hua
- School of Nursing, China Medical University; Department of Nursing, China Medical University Hospital, Taiwan
| | - Ya-Yun Chen
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Taiwan
| | - Jia-Jean Yiin
- Department of General Neurosurgery, Taichung Veterans General Hospital, Taiwan
| | - Kwo-Chen Lee
- School of Nursing, China Medical University; Department of Nursing, China Medical University Hospital, Taiwan
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Forst DA, Kaslow-Zieve ER, Hansen A, Mesa M, Landay SL, Quain KM, Sereno I, El-Jawahri A, Greer JA, Temel JS, Jacobs JM. Characterizing Distress and Identifying Modifiable Intervention Targets for Family Caregivers of Patients with Malignant Gliomas. J Palliat Med 2023; 26:17-27. [PMID: 35708587 DOI: 10.1089/jpm.2021.0534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Individuals caring for patients with malignant gliomas experience high rates of anxiety; however, an in-depth understanding of their distress and evidence-based interventions to target their needs are lacking. Objective: We conducted semistructured interviews with caregivers with elevated anxiety to characterize their drivers of anxiety, identify modifiable intervention targets, and capture their preferences for a psychosocial intervention. Design: From 9/2017 to 3/2019, we conducted semistructured interviews with 21 caregivers of patients with malignant gliomas, at time points following the patient's diagnosis or within one to three months after the patient's death. Setting/Subjects: Eligible caregivers in the United States had clinically significant anxiety as measured by a Hospital Anxiety and Depression Scale-Anxiety score >7. Measurements: Three independent coders employed thematic content analysis to analyze the qualitative data with NVivo 12, achieving high intercoder agreement (Kappa = 0.98). Results: On average, caregivers were 54.81 years old (SD = 10.85) with elevated anxiety (M = 10.90, SD = 3.25). We identified six themes in which caregivers described (1) coping through reassurance seeking or avoidance, (2) changes in their relationship with the patient, (3) challenges with social support, (4) vacillation between certainty and uncertainty regarding the future, (5) devaluation of self-care for the patients' needs, and (6) challenges communicating with the health care team. Caregivers were interested in an intervention soon after the patient's diagnosis, yet expressed concern about finding the time to participate. Conclusions: Emergent themes characterized the distress experienced by caregivers of patients with malignant gliomas and provided insight into their psychosocial intervention preferences. We identified evidence-based intervention components based on the modifiable factors arising from these themes.
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Affiliation(s)
- Deborah A Forst
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Andrea Hansen
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michelle Mesa
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kit M Quain
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Areej El-Jawahri
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie M Jacobs
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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11
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Sousa H, Ribeiro O, Christensen AJ, Figueiredo D. Caring for parents with end-stage renal disease: What do adult children face and how do they cope? J Clin Nurs 2022; 31:3454-3463. [PMID: 34897863 DOI: 10.1111/jocn.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022]
Abstract
AIM This study aimed to explore the stressors and coping strategies of adult children who care for their parents with end-stage renal disease (ESRD) undergoing in-centre haemodialysis. BACKGROUND Given the growing number of older patients with ESRD, adult children are increasingly providing more care and assistance to their parents with this condition. However, little is still known about the experiences of caring for a parent undergoing haemodialysis. DESIGN A qualitative exploratory study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. METHODS Semi-structured face-to-face interviews with nineteen adult children (44.9 ± 11.7 years old) were carried out. Data were transcribed verbatim and subjected to thematic analysis. RESULTS Four stressors (managing disease and treatment-related requirements, patients' reaction to treatment, lack of support from family members, and additional challenges to personal and family life) and five coping strategies (active coping and planning, seeking social support for emotional use, accepting the situation as it is, venting emotions, and maintaining interests outside caring) were identified. CONCLUSION Caring for a parent undergoing haemodialysis is an experience with several challenges, marked by educational needs, emotional distress, lack of support from close relatives and the need to manage multiple responsibilities. RELEVANCE TO CLINICAL PRACTICE Findings highlight the importance of developing interdisciplinary educational and supportive interventions to support this group of caregivers. These interventions should facilitate access to disease and treatment-related information, provide emotional support, and train coping skills to prevent burden and promote healthy adjustment to the demands of ESRD care.
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Affiliation(s)
- Helena Sousa
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Alan J Christensen
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Daniela Figueiredo
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal
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12
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Yao H, Hou Y, Zhang X, Zhang Q. Extrinsic emotional regulation experienced by lung cancer patients and their family caregivers during progression‐free survival. Eur J Cancer Care (Engl) 2022; 31:e13750. [DOI: 10.1111/ecc.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Hong Yao
- School of Ethnology and Sociology Minzu University of China Beijing China
| | - Yajie Hou
- China Population and Development Research Center Beijing China
| | - Xinqian Zhang
- School of Ethnology and Sociology Minzu University of China Beijing China
| | - Qianqian Zhang
- Department of Respiratory and Critical Care Medicine Zhengzhou University People's Hospital Zhengzhou Henan China
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13
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Cieślak M, Kozaka J, Golińska PB, Bidzan M. Mentalization and Its Relation to Life Satisfaction and the Level of Mental Adjustment to Illness in Women with Breast Cancer-A Pilot Study. Int J Environ Res Public Health 2022; 19:10323. [PMID: 36011957 PMCID: PMC9408050 DOI: 10.3390/ijerph191610323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
This study's aim was assessing of the relationship between mentalization and life satisfaction and the level of adaptation to oncological disease in patients with breast cancer. The study involved 41 women (M = 59.88; SD = 8.81) with breast cancer who completed their treatments and participated in a cancer rehabilitation program. In the study, we used the Mentalization Questionnaire (MZQ), the Satisfaction Life Scale (SWLS), and the Mini-Mental Adjustment to Cancer Scale (Mini-MAC). The mean of declared level of mentalization was 45.54 (SD = 11.65). The significant correlation between mentalization (its general value and individual dimensions) and satisfaction with life/mental adjustment to cancer was observed. The strongest positive correlations were noted between refusing self-reflection, helplessness-hopelessness, and anxious preoccupation and the negative correlation between mentalization and satisfaction with life. Mentalization was a predictor of satisfaction with life and mental adjustment to illness. Mentalization was related with life satisfaction and adjustment to cancer in patients with breast cancer, which is in line with previous studies suggesting the crucial role of subjective psychological factors in maintaining mental health.
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Affiliation(s)
- Mariusz Cieślak
- Institute of Psychology, University of Lodz, 90-136 Lodz, Poland
| | - Joanna Kozaka
- Private Counseling Services Joanna Kozaka, 80-414 Gdansk, Poland
| | | | - Mariola Bidzan
- Department of Clinical and Health Psychology, University of Gdansk, 80-309 Gdansk, Poland
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14
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Chan MF, Al-Dhawyani AM, Al Hinai K, Al-Azri M. A cluster analysis to explore the burden of primary caregivers of children with cancer in Oman. J SPEC PEDIATR NURS 2022; 27:e12389. [PMID: 35726717 DOI: 10.1111/jspn.12389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/28/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Few studies have sought to evaluate the risk burden of primary caregivers, particularly in Oman. This study aimed to explore whether different risk patterns of caregiver burden exist among the primary caregivers of Omani children with leukemia. DESIGN AND METHODS A cross-sectional study was conducted between May and November 2020. A total of 101 primary caregivers of children with leukemia were recruited from a public hospital in Oman. The Caregiver Burden Inventory (CBI) was used to assess caregiver burden. RESULTS A two-step cluster analysis indicated that the cohort was not homogeneous (silhouette value: 1.41). Caregivers in Cluster 1 (n = 42; 41.6%) were relatively older, less educated, and had a higher caregiving burden (mean CBI score: 37.7 ± 19.9). In contrast, caregivers in Cluster 2 (n = 59; 58.4%) were younger, more highly educated, and had a moderate caregiving burden (mean CBI score: 26.3 ± 13.6). As such, Clusters 1 and 2 were characterized as the "high-risk" and "moderate-risk" burden groups, respectively. PRACTICE IMPLICATIONS This study highlights the need for a policy draft to target and reduce the caregiver burden in Oman, Nursing professionals should seek to develop and implement customized care depending on the caregiver risk burden, including additional financial, psychological, and physical support. They should seek to stratify caregivers by risk burden as some groups may require additional support. However, in light of recent precautionary measures due to the current pandemic situation, such services will have to be provided online or via telephone instead of in person for the foreseeable future.
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Affiliation(s)
- Moon Fai Chan
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | | | - Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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15
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Santerre-Theil A, Brown TL, Körner A, Loiselle CG. Exploring healthcare professionals' experiences with informal family cancer caregiving. Support Care Cancer 2022; 30:7745-7754. [PMID: 35701633 PMCID: PMC9197331 DOI: 10.1007/s00520-022-07207-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
Caring for a family member with cancer is often associated with significant cognitive, emotional, and physical demands. Although considerable research has explored informal cancer caregiver role burden, research has seldom focused on the experiences of individuals who hold the dual role of informal caregiver and healthcare professional. This qualitative study begins to explore this dual role experience. Participants (N = 12) who had at least 1 year of prior professional experience and cared for a family member with cancer were recruited conveniently from a large university-affiliated hospital in Montreal, Quebec. Individual face-to-face semi-structured interviews were conducted. Using thematic analysis, key themes were developed from verbatim transcripts: (1) salient dual role advantages, (2) significant challenges related to this role, (3) changes in professional practice as a consequence of informal caregiving, and (4) important palliative and end-of-life care access issues. Whereas professional knowledge helped advocate on behalf of patients, the dual role often came with over-solicitation from others, enhanced sense of responsibility, increased burden, and significant distress. Further study of critical ramifications linked to jointly enacting informal and professional caregiving across various health contexts should continue to inform supportive care strategies for this understudied yet increasingly prevalent segment of the caregiver population.
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Affiliation(s)
- Ariane Santerre-Theil
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
| | - Tyler L Brown
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Annett Körner
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada
- Psychosocial Oncology Program, McGill University Health Centre, Montreal, QC, Canada
| | - Carmen G Loiselle
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada.
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
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16
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Salehi D, Zarani F, Fata L, Sharbafchi MR, Lobb E. I didn't want to remember memories of caring, but I can't help it": A qualitative study of the experiences of bereaved Iranian carers with elevated levels of prolonged grief symptoms. Death Stud 2022; 47:139-148. [PMID: 35147075 DOI: 10.1080/07481187.2022.2036270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The lived experience of caring for people with cancer and the influence of culture on Iranian carers who have elevated levels of prolonged grief symptoms after the death has received little in-depth attention. Bereaved carers (N = 17) were interviewed. All showed high levels of prolonged grief symptoms. Thematic analysis resulted in four overarching themes: unfamiliarity with cancer, high involvement in carer's role, lack of processing events, and emptiness. The way that carers of cancer patients understand and cope with their caring role and their dominant cultural context can make their grieving process complex.
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Affiliation(s)
- Delaram Salehi
- Department of Psychology, Shahid Behashti University, Tehran, Iran
| | - Fariba Zarani
- Department of Psychology, Shahid Behashti University, Tehran, Iran
| | - Ladan Fata
- Department of Psychology, Iran University of medical Sciences, Tehran, Iran
| | - Mohammad Reza Sharbafchi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences and Ala Cancer Prevention and Control Center, Isfahan, Iran
| | - Elizabeth Lobb
- Calvary Palliative and End of Life Care Research Institute, Calvary Health Care, Kogarah, Australia
- School of Medicine, University of Notre Dame, Darlinghurst, Australia
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17
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Lefebvre T, Tack L, Meersman M, Vanneste H, Cool L, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, De Backer J, Chandler R, Lane P, Boterberg T, R. Debruyne P. Developing and evaluating a participatory arts programme for cancer patients and their caregivers. Acta Clin Belg 2022; 77:18-24. [PMID: 32515661 DOI: 10.1080/17843286.2020.1773653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Cancer patients, survivors and caregivers often encounter severe distress, having significant consequences to wellbeing, functionality and physical health. This study developed and evaluated a participatory arts programme to determine if such could help to improve the wellbeing of cancer patients and their caregivers. METHODS To inform the development of a participatory arts programme, cancer patients and their caregivers at an Organisation of European Cancer Institute (OECI)-designated cancer centre were asked which activities they would wish to engage in (anonymous survey one). A programme was then developed and trialled for 1 year. Following participation, we explored the satisfaction and any benefits of taking part (anonymous survey two). RESULTS Survey one had a participation rate of 70%. In this survey, participants indicated they preferred group-based activities (61%) over an individual approachto take place on a monthly basis (46%). The developed programme ran from December 2018 to December 2019, with 435 patients and caregivers taking part. Two hundred and eighteen completed survey two and revealed a positive response to both the structure and content of the programme and its impact on the wellbeing of patients and caregivers. The majority indicated they felt (much) betterfrom participating in the participatory arts programme. CONCLUSION This study points out the interest and potential value of a participatory arts programme to the perceived wellbeing. This suggests such programmes could be incorporated into cancer care provision, to serve as psychosocial support. The latter is particularly relevant for improving the lives, wellbeing and health of cancer patients and those supporting them.
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Affiliation(s)
- Tessa Lefebvre
- Department of Medical Oncology, General Hospital Groeninge, Kortrijk, Belgium
- Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Laura Tack
- Department of Medical Oncology, General Hospital Groeninge, Kortrijk, Belgium
- Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Marlies Meersman
- Department of Medical Oncology, General Hospital Groeninge, Kortrijk, Belgium
| | - Hilde Vanneste
- Department of Medical Oncology, General Hospital Groeninge, Kortrijk, Belgium
| | - Lieselot Cool
- Department of Medical Oncology, General Hospital Groeninge, Kortrijk, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Koen Van Eygen
- Department of Haematology, General Hospital Groeninge, Kortrijk, Belgium
| | - Karin Stellamans
- Department of Radiation Oncology, General Hospital Groeninge, Kortrijk, Belgium
| | - Sofie Derijcke
- Department of Respiratory Medicine, General Hospital Groeninge, Kortrijk, Belgium
| | - Philippe Vergauwe
- Department of Gastro-enterology, General Hospital Groeninge, Kortrijk, Belgium
| | - Jos De Backer
- Department of Music, LUCA School of Arts, Association KULeuven, Leuven, Belgium
| | - Rebecca Chandler
- Positive Ageing Research Institute (PARI), Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Pauline Lane
- Positive Ageing Research Institute (PARI), Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Tom Boterberg
- Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Philip R. Debruyne
- Department of Medical Oncology, General Hospital Groeninge, Kortrijk, Belgium
- Positive Ageing Research Institute (PARI), Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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18
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Hui-Lin C, Ting G. The experiences, perceptions, and support needs among family caregivers of patients with advanced cancer and eating problems: An integrative review. Palliat Med 2022; 36:219-236. [PMID: 35188004 DOI: 10.1177/02692163211058598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Advanced cancer patients often present with numerous eating problems, posing a significant challenge for family caregivers during the provision of nutritional care. AIM To systematically identify and synthesize empirical literature on the experiences, perceptions, and support needs of family caregivers of patients with advanced cancer and eating problems to ascertain directions for future research. DESIGN Integrative review guided by Whittemore and Knafl's methodological framework. DATA SOURCES Five electronic databases were searched from their inception to April 2021. Studies were eligible if they examined family caregivers' perspectives and experiences when caring for their relatives with advanced cancer and eating problems and were primary quantitative, qualitative, and mixed-methods studies published in English-language peer-reviewed journals. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. RESULTS Twenty-seven papers from 21 studies met the eligibility criteria and were included in this review. The included papers were mostly qualitative studies and were of moderate to high methodological quality. Three themes were identified: (a) multiple negative effects of advanced cancer patients' eating problems; (b) coping responses in managing advanced cancer patients' eating problems; and (c) unmet support needs in the provision of nutritional care. CONCLUSIONS Research on the studied topic was descriptive and predominantly qualitative in nature. Quantitative research examining the impact of caregiving experiences in relation to food and eating in the context of advanced cancer patients is the first important step moving this research area forward.
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Affiliation(s)
- Cheng Hui-Lin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Gan Ting
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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19
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Qan'ir Y, Guan T, Idiagbonya E, Dobias C, Conklin JL, Zimba CC, Bula A, Jumbo W, Wella K, Mapulanga P, Bingo S, Chilemba E, Haley J, Montano NP, Bryant AL, Song L. Quality of life among patients with cancer and their family caregivers in the Sub-Saharan region: A systematic review of quantitative studies. PLOS Glob Public Health 2022; 2:e0000098. [PMID: 36962119 PMCID: PMC10021310 DOI: 10.1371/journal.pgph.0000098] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
Guided by the World Health Organization quality of life (WHOQOL) framework, this systematic review aimed to examine evidence about the prevalence and severity of QOL-related health problems and their influencing factors in Sub-Saharan Africa (SSA). We identified eligible publications in English language from PubMed, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text, Embase, APA PsycInfo, Scopus, and African Index Medicus databases. We included quantitative descriptive studies that measured overall and subdomains of QOL as the outcome in adult patients/survivors with cancer in SSA. Twenty-six descriptive cross-sectional studies (27 papers) that were conducted since 1988 in different SSA countries among patients with various types of cancer met our inclusion criteria. We found inconsistencies in how the prevalence and severity of QOL-related health problems have been researched and reported across studies, which complicated comparing findings and drawing conclusions. The most common factors that influenced the overall and subdomains of QOL included coping; internal and external locus of control; symptoms and symptom management; and religious beliefs and religious care. Demographics (e.g., age and marital status), cancer-related factors (cancer stage and type of treatment), and social determinants of health (e.g., education, access to information and resources, financial distress, and urban vs rural residency) also impacted QOL and its subdomains. Our findings indicate the significant need for recognizing and managing QOL-related problems for cancer patients and caregivers in SSA. Research needs to use culturally adapted, standardized assessment tools and analysis approaches to better understand the QOL challenges this population faces. Comprehensive supportive care is needed to address the complex QOL issues in resource-limited SSA.
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Affiliation(s)
- Yousef Qan'ir
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Ting Guan
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Eno Idiagbonya
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Cloie Dobias
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Jamie L Conklin
- Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | | | - Agatha Bula
- University of North Carolina (UNC) Project, Lilongwe, Malawi
| | - Wongani Jumbo
- University of North Carolina (UNC) Project, Lilongwe, Malawi
| | | | | | | | | | - Jennifer Haley
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Nilda Peragallo Montano
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Ashley Leak Bryant
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Lixin Song
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC, United States of America
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20
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Taib F, Beng KT, Chan LC. The Challenges, Coping Mechanisms, and the Needs of the Inhospital Parents Caring for Children with Life-limiting Neurological Disorders: A Qualitative Study. Indian J Palliat Care 2021; 27:483-489. [PMID: 34898942 PMCID: PMC8655653 DOI: 10.25259/ijpc_3_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Parents who have children with complex lifelong and life-limiting neurological conditions experienced many stresses and anxieties throughout their lives as caregivers. However, this information is still very limited. The study aimed to explore the challenges faced by parents with children who have complex neurological conditions, their coping strategies, needs, and expectations. Materials and Methods A semi-structured, in-depth interviews were conducted in the either Malay or English language among the parents of children with complex lifelong neurological conditions and have been on long-term in-patient hospital care. The interviews were audio-recorded and transcribed for thematic analysis. The qualitative study was conducted from October to November 2016 at the Paediatric Institute of Hospital Kuala Lumpur. Grounded theory was used to examine the qualitative data with inductive and deductive types of coding. The transcripts were read repeatedly to allow familiarity to the themes presented by the participants. Further discussions were conducted among the researchers to triangulate the information. Results A total of 11 parents were interviewed for this study. The thematic analysis resulted in 8 challenges: Physical wellbeing, Environment, Relationship, Financial, Occupational, Rational, Mental, and Spiritual. Coping strategies comprised problem focused issues related to the key challenges in the caregivers' context. Similar to the needs and expectations, the key themes were derived from the key understandings of the challenges and looking at the palliative care impacts for these children. Conclusion There are various challenges faced by parents of children with life-limiting neurological disorders. Physical, Environment, Relationship, Financial, Occupational, Rational, Mental, and Spiritual Wellbeing can be a platform for the assessment of the caregivers' needs and the planning for palliative care support.
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Affiliation(s)
- Fahisham Taib
- Department of Paediatrics, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Khoo Teik Beng
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Lee Chee Chan
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
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Abstract
INTRODUCTION Lung transplantation is a treatment crucial for the survival of patients with end-stage lung diseases. An identified caregiver is obligatory for a patient to be eligible for a lung transplant and plays an essential role in the transplant recipient's care. Most caregiver research, however, has been on caregivers of persons with Alzheimer's disease or the elderly, with limited research on caregivers' experiences caring for transplant recipients. This study examined the experiences of caregivers of recipient's pre- and post-lung transplantation. METHODS/APPROACH Caregivers of lung transplant recipients were recruited using purposeful sampling. Audiotaped semi-structured open ended interviews were conducted until data saturation. Each interview was transcribed verbatim, and conventional content analysis performed to extract significant themes and subthemes. FINDINGS Four main themes and 12 sub-themes were identified. The former included (1) establishing the diagnosis, (2) caregiver roles, (3) caregiver psychological and psychosocial issues, and (4) support. Caregivers lacked basic knowledge related to lung transplantation. The caregivers' roles necessitated rearranging priorities, lifestyle changes, and redirecting emotional and physical energy. Support played an important role in caregiving experiences. DISCUSSION Each caregiver shared their unique caregiving experiences. Caregivers lack knowledge about transplantation, experience dramatic changes in their family life, social activities, employment, and often financial status. Healthcare providers can use the findings of this study in developing informational, and psychological interventions to alleviate caregivers' stress and anxiety.
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Affiliation(s)
- Joy A Glaze
- Miami Transplant Institute, 23215Jackson Memorial Hospital/University of Miami School, Miami, Florida, USA
| | - Dorothy Brooten
- 15803Florida International University, Nichole Wertheim College of Nursing & Health Sciences, Miami, Florida, USA
| | - Jo Anne Youngblut
- 15803Florida International University, Nichole Wertheim College of Nursing & Health Sciences, Miami, Florida, USA
| | - Jean Hannan
- 15803Florida International University, Nichole Wertheim College of Nursing & Health Sciences, Miami, Florida, USA
| | - Timothy Page
- 2814Nova Southeastern University, Fort Lauderdale, Florida, USA
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22
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Acquati C, Hibbard JH, Miller-Sonet E, Zhang A, Ionescu E. Patient activation and treatment decision-making in the context of cancer: examining the contribution of informal caregivers' involvement. J Cancer Surviv 2021. [PMID: 34510365 DOI: 10.1007/s11764-021-01085-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/02/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE The present work investigated the relationship between patient activation, treatment decision-making, and adherence to the prescribed treatment regimen. Given the role of informal caregivers in patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship. METHODS Survey data collected from 504 cancer survivors were utilized. Structural equation modeling (SEM) controlling for covariates was used to examine the relationship between patient activation measure (PAM), caregiver involvement, and the identified outcomes. Moderator analysis was conducted using multiple group SEM. RESULTS Patient activation was significantly associated with treatment planning being reflective of survivors' goals and values (p < 0.001); adherence to treatment (p = 0.011); and satisfaction (p < 0.001). Caregiver's involvement significantly moderated the association between activation and adherence to treatment. CONCLUSIONS Patient activation was positively associated with all three selected outcomes. However, for cancer survivors reporting low rates of caregiver's involvement, patient activation was not associated with treatment adherence. Research is needed to test and deliver self-management interventions inclusive of informal caregivers. IMPLICATIONS FOR CANCER SURVIVORS Findings supported the need not only to monitor and sustain patient activation across the cancer continuum, but also to assume a dyadic perspective when designing self-management interventions in cancer survivorship.
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23
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Song L, Qan'ir Y, Guan T, Guo P, Xu S, Jung A, Idiagbonya E, Song F, Kent EE. The Challenges of Enrollment and Retention: A Systematic Review of Psychosocial Behavioral Interventions for Patients With Cancer and Their Family Caregivers. J Pain Symptom Manage 2021; 62:e279-e304. [PMID: 33933618 PMCID: PMC8419067 DOI: 10.1016/j.jpainsymman.2021.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT Psychosocial behavioral interventions (PBIs) that target patients with cancer and their caregivers face challenges in participant enrollment and retention. OBJECTIVES 1) Describe characteristics of the patient-caregiver PBI studies; 2) examine participant enrollment and retention rates; 3) identify factors influencing participant enrollment and retention rates; and 4) explore the strategies to promote enrollment and retention rates. METHODS We identified randomized controlled trials that tested PBIs among adult patients with cancer and caregivers in five electronic databases. We conducted narrative and quantitative analyses to synthesize our findings. RESULTS Among 55 qualified studies reviewed, most tested the efficacy of PBIs (n = 42) and used two study arms (n = 48). In-person meeting was the most common PBI delivery mode. The primary outcomes included quality of life, physical health, and symptoms. The average of enrollment rates of patient-caregiver dyads was 33% across studies (range 8%-100%; median = 23%). The average retention rate at the end of follow-ups was 69% (range 16%-100%; median = 70%). The number of study arms, recruitment method, type of patient-caregiver relationship, and intervention duration influenced enrollment rates. Study design (efficacy vs. pilot), follow-up duration, mode of delivery, type of relationship, and intervention duration influenced retention rates. Sixteen studies reported retention strategies, including providing money/gift cards upon study completion and/or after follow-up survey, and excluding patients with advanced cancer. CONCLUSION Researchers need to incorporate effective strategies to optimize enrollment and retention in patient-caregiver PBI trials. Researchers need to report detailed study processes and PBI information to improve research transparency and increase consistency.
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Affiliation(s)
- Lixin Song
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA; University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
| | - Yousef Qan'ir
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Ting Guan
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, North Carolina, USA
| | - Peiran Guo
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Shenmeng Xu
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Ahrang Jung
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Eno Idiagbonya
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Fengyu Song
- West Coast University, General Education, Anaheim, California, USA
| | - Erin Elizabeth Kent
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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24
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Ekwonye AU, Truong N. Searching and Making Meaning of the COVID-19 Pandemic: Perspectives of African Immigrants in the United States. Journal of Humanistic Psychology 2021. [DOI: 10.1177/00221678211022442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African immigrants continue to be disproportionately affected by the COVID-19 pandemic. It is unclear how they are searching for and finding meaning in the face of this adversity. This study sought to understand how African immigrants in the United States are searching for and making meaning of the COVID-19 pandemic. We conducted in-depth interviews remotely with 20 immigrants from West Africa (Nigeria and Ghana), East Africa (Somali and Rwanda), and Central Africa (Democratic Republic of Congo). The meaning-making model was used as a framework to understand the processes of coping during a significant, adverse life event. The study found that some participants attempted to reduce the impact of the COVID-19 pandemic on their global meaning by seeking answers as to why the pandemic occurred and creating positive illusions. Some redefined their priorities and reframed the pandemic in a positive light. Participants found meaning in the form of accepting the pandemic as a reality of life, appreciating events previously taken for granted, and making positive changes in their lives. This study’s findings can inform health care providers of the meaning-making processes of African immigrants and the need to assist them in their search for meaning.
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25
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Otto AK, Soriano EC, Birmingham WC, Vadaparampil ST, Heyman RE, Ellington L, Reblin M. Impact of Relationship and Communication Variables on Ambulatory Blood Pressure in Advanced Cancer Caregivers. Ann Behav Med 2021; 56:405-413. [PMID: 34244701 DOI: 10.1093/abm/kaab057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer impacts both patients and their family caregivers. Evidence suggests that caregiving stress, including the strain of taking on a new role, can elevate the risk of numerous health conditions, including high blood pressure (BP). However, the caregiver's psychosocial experiences, including their interpersonal relationship with the patient, may buffer some of the negative physiological consequences of caregiving. PURPOSE To examine the influence of psychosocial contextual variables on caregiver ambulatory BP. METHODS Participants were 81 spouse-caregivers of patients with advanced gastrointestinal or thoracic cancer. For an entire day at home with the patient, caregivers wore an ambulatory BP monitor that took readings at random intervals. Immediately after each BP reading, caregivers reported on physical circumstances (e.g., posture, activity) and psychosocial experiences since the last BP measurement, including affect, caregiver and patient disclosure, and role perceptions (i.e., feeling more like a spouse vs. caregiver). Multilevel modeling was used to examine concurrent and lagged effects of psychosocial variables on systolic and diastolic BP, controlling for momentary posture, activity, negative affect, and time. RESULTS Feeling more like a caregiver (vs. spouse) was associated with lower systolic BP at the same time point. Patient disclosure to the caregiver since the previous BP reading was associated with higher diastolic BP. No lagged effects were statistically significant. CONCLUSIONS Caregivers' psychosocial experiences can have immediate physiological effects. Future research should examine possible cognitive and behavioral mechanisms of these effects, as well as longer-term effects of caregiver role perceptions and patient disclosure on caregiver psychological and physical health.
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Affiliation(s)
- Amy K Otto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Emily C Soriano
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | | | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, NY, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,College of Medicine, University of Vermont, Burlington, VT, USA
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26
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Moss KO, Douglas SL, Lipson AR, Blackstone E, Williams D, Aaron S, Wills CE. Understanding of Health-related Decision-making Terminology Among Cancer Caregivers. West J Nurs Res 2021; 43:649-659. [PMID: 33063642 PMCID: PMC8050115 DOI: 10.1177/0193945920965238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Research on understanding health-related decision-making terminology among family caregivers of adults living with advanced cancer is lacking. The purpose of this study was to examine interpretations of the meaning of health-related decision-making terminology such as quality-of-life and end-of-life among caregivers of adults living with advanced cancer as a basis for improved understanding of caregiver decision support needs. Interviews were conducted with a purposive sub-sample of 10 caregivers of adults diagnosed with advanced cancer who completed a longitudinal, descriptive study (NRO14856) of factors influencing cancer care decisions. Audio transcripts were analyzed using qualitative descriptive methods. Caregivers described interpretations of the meaning and process of decision-making and decision-related distress. Caregivers were uncertain about the meaning of end-of-life-related terminology, and a placed high value on quality-of-life and faith/spirituality in the decision-making process. Improvements in information and decision support interventions are needed to better support caregivers and subsequently patients towards informed cancer care decisions.
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Affiliation(s)
- Karen O Moss
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Sara L Douglas
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Amy R Lipson
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Eric Blackstone
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Dionne Williams
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Siobhan Aaron
- Interdisciplinary Training in Cancer, Caregiving, and End-of-Life Care, College of Nursing, University of Utah, USA
| | - Celia E Wills
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH, USA
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27
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Yu W, Lu Q, Lu Y, Yang H, Zhang L, Guo R, Hou X. Anticipatory Grief among Chinese Family Caregivers of Patients with Advanced Cancer: A Cross-Sectional Study. Asia Pac J Oncol Nurs 2021; 8:369-376. [PMID: 34159229 PMCID: PMC8186392 DOI: 10.4103/apjon.apjon-214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/10/2021] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this study was to explore the interrelationship between anticipatory grief (AG), caregiver burden, communication, preparation for death, and coping style. Methods A convenience sample of 256 Chinese family caregivers of patients with advanced cancer were recruited from an academic cancer hospital between April 2018 and May 2019. This cross-sectional survey included the AG Scale, caregiver burden (Caregiver Reaction Assessment), communication (Caregivers' Communication with Patients about Illness and Death Scale), preparation for death, and coping style (Simplified Coping Style Questionnaire). Structural equation modeling tested the interrelation between them. Results The final model fitted the data acceptably (χ2 = 25.79, degrees of freedom = 17, P = 0.08, root mean square error of approximation = 0.05, goodness-of-fit index [GFI] = 0.98, adjusted GFI [AGFI] = 0.95, parsimony GFI [PGFI] = 0.46, normed fit index = 0.94, comparative fit index = 0.98). Poor communication contributed to less preparation for death and caregiver burden, which further aggravate AG. Communication was positively associated with AG. In addition, communication and positive coping style interacted to further influence caregiver burden. Conclusions Preliminary results supported the model and showed that poor communication, less preparation for death, and caregiver burden contributed to AG while positive coping alleviated AG. Findings suggest the need for further studies to explore effective intervention for communication, preparation for death, burden, and coping style of caregivers to ultimately alleviate AG.
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Affiliation(s)
- Wenhua Yu
- Department of Thoracic Surgical Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Qian Lu
- School of Nursing, Peking University, Beijing, China
| | - Yuhan Lu
- Department of Nursing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Hong Yang
- Department of Nursing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lichuan Zhang
- School of Nursing, Peking University, Beijing, China
| | - Renxiu Guo
- Department of Digestive Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaoting Hou
- Department of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
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28
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Tack L, Lefebvre T, Blieck V, Cool L, Pottel H, Eygen KV, Derijcke S, Vergauwe P, Schofield P, Chandler R, Lane P, Boterberg T, Debruyne PR. Acupuncture as a Complementary Therapy for Cancer Care: Acceptability and Preferences of Patients and Informal Caregivers. J Acupunct Meridian Stud 2021; 14:67-74. [DOI: 10.51507/j.jams.2021.14.2.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/11/2021] [Accepted: 02/21/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Laura Tack
- Department of Medical Oncology, Kortrijk Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Tessa Lefebvre
- Department of Medical Oncology, Kortrijk Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Virginie Blieck
- College for Traditional Chinese Medicine & Karel de Grote University College, Antwerp, Belgium
| | - Lieselot Cool
- Department of Medical Oncology, Kortrijk Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care at Kulak, Catholic University Leuven Kulak, Kortrijk, Belgium
| | - Koen Van Eygen
- Department of Haematology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Sofie Derijcke
- Department of Pneumology, General Hospital Groeninge, Kortrijk, Belgium
| | - Philippe Vergauwe
- Department of Gastro-Enterology, General Hospital Groeninge, Kortrijk, Belgium
| | | | - Rebecca Chandler
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Pauline Lane
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Philip R. Debruyne
- Department of Medical Oncology, Kortrijk Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- School of Life Sciences, Anglia Ruskin University, Cambridge, United Kingdom
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29
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Suo R, Zhang L, Tao H, Ye F, Zhang Y, Yan J. The effects of dyadic coping and marital satisfaction on posttraumatic growth among breast cancer couples. Support Care Cancer 2021; 29:5425-5433. [PMID: 33709185 DOI: 10.1007/s00520-021-06121-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/02/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVES To examine the dyadic relationships of dyadic coping, marital satisfaction, and posttraumatic growth and to confirm the mediating effect of marital satisfaction between dyadic coping and posttraumatic growth among breast cancer patients and their spouses. METHODS A total of 206 pairs of female breast cancer patients and their spouses from one tertiary hospital in Guangzhou, China, from August 2018 to July 2019 were invited to complete the demographics and disease-related information questionnaire, the Posttraumatic Growth Inventory, the Marital Adjustment Scale, and the Dyadic Coping Inventory. RESULTS Patients' and spouses' positive/negative dyadic coping exerted actor effects and partner effects on marital satisfaction, while their marital satisfaction and positive dyadic coping only exerted actor effects on posttraumatic growth. In addition, the mediating effects of marital satisfaction on the impact of dyadic coping on posttraumatic growth were confirmed in both patients and spouses. CONCLUSION Our findings provide a new perspective on the relationships between dyadic coping, marital satisfaction, and posttraumatic growth at the individual and dyadic levels. Promoting positive dyadic coping and decreasing negative dyadic coping among breast cancer patients and spouses can improve their marital satisfaction and posttraumatic growth.
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Affiliation(s)
- Rongfei Suo
- Fifth Affiliated Hospital Sun Yat-Sen University, No. 52, Meihua East Road, Xiangzhou District, Zhuhai, Guangdong Province, People's Republic of China.,School of Nursing, Sun Yat-Sen University, No. 74, Zhongshan II Road, Guangzhou, Guangdong Province, People's Republic of China
| | - Lijuan Zhang
- Cancer Center, Sun Yat-Sen University, No. 651, Dongfengdong Road, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongmei Tao
- Fifth Affiliated Hospital Sun Yat-Sen University, No. 52, Meihua East Road, Xiangzhou District, Zhuhai, Guangdong Province, People's Republic of China
| | - Fenglian Ye
- Fifth Affiliated Hospital Sun Yat-Sen University, No. 52, Meihua East Road, Xiangzhou District, Zhuhai, Guangdong Province, People's Republic of China
| | - Yuening Zhang
- Zhongshan School of Medicine, Sun Yat-Sen University, No. 74, Zhongshan II Road, Guangzhou, Guangdong Province, People's Republic of China
| | - Jun Yan
- School of Nursing, Sun Yat-Sen University, No. 74, Zhongshan II Road, Guangzhou, Guangdong Province, People's Republic of China.
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30
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Long NX, Ngoc NB, Phung TT, Linh DTD, Anh TN, Hung NV, Thang NT, Lan NTM, Trang VT, Thuong NH, Van Hieu N, Van Minh H. Coping strategies and social support among caregivers of patients with cancer: a cross-sectional study in Vietnam. AIMS Public Health 2021; 8:1-14. [PMID: 33575403 PMCID: PMC7870390 DOI: 10.3934/publichealth.2021001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/08/2020] [Indexed: 11/19/2022] Open
Abstract
Research on coping strategies and social support among Vietnamese cancer caregivers remains limited. In this study, we aim to examine the relationships between types of coping strategies utilized and social support among cancer caregivers. This was a cross-sectional study conducted in three main cancer hospitals in the Northern, Central and Southern regions of Vietnam. The 28-item Brief COPE Inventory (BCI) Scale and the Multidimensional Scale of Perceived Social Support (MSPSS) were utilized. Descriptive statistics and multivariate linear regression were performed. Active coping, acceptance and positive reframing were the most used coping strategies among participants, while substance use was the least commonly used. Level of social support was positively correlated with the utilization of coping mechanisms. Receiving high social support and utilizing positive coping strategies enables caregivers to mitigate their caregiving burden, control the situation and enhance their own quality of life.
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Affiliation(s)
- Nguyen Xuan Long
- University of Languages and International Studies, Vietnam National University, Hanoi, Vietnam
| | - Nguyen Bao Ngoc
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Tran Thi Phung
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Dao Thi Dieu Linh
- University of Languages and International Studies, Vietnam National University, Hanoi, Vietnam
| | - Ta Nhat Anh
- University of Languages and International Studies, Vietnam National University, Hanoi, Vietnam
| | - Nguyen Viet Hung
- International School, Vietnam National University, Hanoi, Vietnam
| | - Nguyen Thi Thang
- University of Languages and International Studies, Vietnam National University, Hanoi, Vietnam
| | - Nguyen Thi Mai Lan
- Graduate Academy of Social Sciences, Vietnam Academy of Social Sciences, Hanoi, Vietnam
| | - Vu Thu Trang
- Graduate Academy of Social Sciences, Vietnam Academy of Social Sciences, Hanoi, Vietnam
| | | | | | - Hoang Van Minh
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
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31
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Onu DU, Ugwu DI. Negative centralisation of HIV trauma influences health-related quality of life: Does posttraumatic growth buffer the link? International Journal of Africa Nursing Sciences 2021. [DOI: 10.1016/j.ijans.2021.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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32
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Kochli-Hailovski T, Marai I, Lorber A, Cohen M. Providing regular grandchild care: Grandparents' psychological and physical health. Geriatr Nurs 2020; 42:173-180. [PMID: 32950275 DOI: 10.1016/j.gerinurse.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine the associations between intensity of providing regular grandchild care and positive affect (PA) and negative affect (NA), heart rate variability (HRV) and somatic symptoms. METHODS This was a cross-sectional study involving 104 individuals (aged 59-82) who provide at least 5 h a week of regular care for their grandchildren. The study model was assessed using structural equation modeling. RESULTS Intensity of regular care (mean hours per week: M = 14.8, SD = 11.2) was associated with higher PA and lower NA. Higher perceived role overload, higher NA and lower PA were associated with lower HRV and somatic symptoms. The fit indices indicated a good model fit. CONCLUSIONS The results suggest that healthcare professionals should be aware of the positive and negative implications of caring for grandchildren on their older patients, including the increased risk of future morbidity, as indicated by lower HRV.
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Affiliation(s)
| | - Ibrahim Marai
- Cardiology Department, The Baruch Padeh Medical Center, Poriya, Israel.
| | - Abraham Lorber
- Department of Pediatric Cardiology & Congenital Heart Disease in Adults, Rambam Health Care Campus, Haifa, Israel.
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel.
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33
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Taylor J, Fradgley E, Clinton-McHarg T, Byrnes E, Paul C. What are the sources of distress in a range of cancer caregivers? A qualitative study. Support Care Cancer 2020; 29:2443-2453. [PMID: 32929537 DOI: 10.1007/s00520-020-05742-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Caring for a person diagnosed with cancer is associated with elevated distress that may impact on caregiver health and patient outcomes. However, caregivers' distress is relatively under-researched. This Australian study explored a range of caregivers' reported sources of distress. METHODS The grounded theory approach informed semi-structured interviews that were conducted with a purposive and broad range sample of distressed caregivers identified through the 'Structured Triage And Referral by Telephone' (START) trial. A grounded theory framework was used to generate themes with data analysed by two independent coders using the NVivo software. RESULTS Caregivers (n = 14) were aged from 25 to 80 years, including two bereaved caregivers. The relationships of the caregivers to the patients were as follows: partner (n = 8), parent (n = 1), child (n = 3), sibling (n = 1), and friend (n = 1). Six major themes emerged in relation to sources of distress: (1) a lack of sufficient and timely information; (2) uncertainty; (3) the role and duties of caregiving; (4) lack of family-centred services; (5) practical challenges; and (6) impact of distress. CONCLUSION Caregivers face a number of specific challenges beyond those experienced by patients. It is essential to ensure that caregivers are actively well-informed and well-supported alongside the person who is diagnosed with cancer.
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Affiliation(s)
- Jo Taylor
- School of Medicine and Public Health, University of Newcastle, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia. .,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia. .,Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.
| | - Elizabeth Fradgley
- School of Medicine and Public Health, University of Newcastle, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Cancer Institute New South Wales, Eveleigh, Australia
| | - Tara Clinton-McHarg
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,School of Psychology, University of Newcastle, Callaghan, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Generational Health and Aging, University of Newcastle, Callaghan, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Hunter Research Cancer Alliance, HMRI Building, New Lambton Heights, Australia
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Segrin C, Badger TA, Sikorskii A, Pasvogel A, Weihs K, Lopez AM, Chalasani P. Longitudinal dyadic interdependence in psychological distress among Latinas with breast cancer and their caregivers. Support Care Cancer 2020; 28:2735-43. [PMID: 31707502 DOI: 10.1007/s00520-019-05121-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Cancer diagnosis and treatment can generate substantial distress for both survivors and their family caregivers. The primary aim of this investigation is to test a model of dyadic interdependence in distress experienced by cancer survivors and their caregivers to determine if each influences the other. METHODS To test this prediction, 209 Latinas with breast cancer and their family caregivers (dyads) were followed for 4 waves of assessment over the course of 6 months. Both psychological (depression, anxiety, perceived stress) and physical (number of symptoms, symptom distress) indicators of distress were assessed. Longitudinal analyses of dyadic data were performed in accordance with the actor-partner interdependence model. RESULTS Findings indicated that psychological distress was interdependent between cancer survivors and their caregivers over the 6 months of observation. However, there was no such evidence of interdependence on indicators of physical distress. CONCLUSIONS These findings are consistent with emotional contagion processes and point to the potential importance of caregiver well-being for the welfare of Latina breast cancer survivors.
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35
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Ramos-Campos M, Redolat R, Mesa-Gresa P. The Mediational Role of Burden and Perceived Stress in Subjective Memory Complaints in Informal Cancer Caregivers. Int J Environ Res Public Health 2020; 17:ijerph17072190. [PMID: 32218278 PMCID: PMC7177542 DOI: 10.3390/ijerph17072190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 01/19/2023]
Abstract
The role of informal caregiver of cancer patients is considered a situation of chronic stress that could have impact on cognitive functioning. Our aim was to evaluate differences in perceived stress, subjective memory complaints, self-esteem, and resilience between caregivers and non-caregivers, as well as the possible mediational role of burden in caregivers. The sample was composed of 60 participants divided into two groups: (1) Primary informal caregivers of a relative with cancer (CCG) (n = 34); and (2) non-caregiver control subjects (Non-CG) (n = 26). All participants were evaluated through a battery of tests: Socio-demographic questionnaire, subjective memory complaints questionnaire (MFE-30), Rosenberg Self-Esteem Scale, resilience (CD-RISC-10), and perceived stress scale (PSS). The CCG group also completed the Zarit burden interview. Results indicated that CCG displayed higher scores than Non-CG in MFE-30 (p = 0.000) and PSS (p = 0.005). In the CCG group, Pearson correlations indicated that PSS showed a negative relationship with resilience (p = 0.000) and self-esteem (p = 0.002) and positive correlation with caregiver’s burden (p = 0.015). In conclusion, CCG displayed higher number of subjective memory complaints and higher perceived stress than Non-CG, whereas no significant differences were obtained on self-esteem and resilience. These results could aid in designing new intervention strategies aimed to diminish stress, burden, or cognitive effects in informal caregivers of cancer patients.
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Affiliation(s)
- Marta Ramos-Campos
- Junta asociada provincial de Valencia de la Asociación Española contra el Cáncer, 46010 Valencia, Spain;
- Psychobiology Department, Universitat de València, 46010 Valencia, Spain;
| | - Rosa Redolat
- Psychobiology Department, Universitat de València, 46010 Valencia, Spain;
| | - Patricia Mesa-Gresa
- Psychobiology Department, Universitat de València, 46010 Valencia, Spain;
- Correspondence: ; Tel.: +34-96-398-3985
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Segrin C, Badger T, Sikorskii A. Psychological Distress and Social Support Availability in Different Family Caregivers of Latinas With Breast Cancer. J Transcult Nurs 2019; 32:103-110. [DOI: 10.1177/1043659619896824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Latinas with breast cancer draw on a diverse range of family members for informal care. Latin cultures typically prescribe high levels of support and care for an ill family member that leave caregivers vulnerable to compromised well-being. Method: In this cross-sectional survey study, 258 family caregivers of Latinas with breast cancer completed reports of psychological distress, availability of social support, and acculturation. Results: Mothers who provide care to a daughter with breast cancer experience higher levels of psychological distress and report lower availability of informational support than most other types of family caregivers. Mothers’ lower levels of acculturation may at least partially explain these reductions in well-being. Discussion: This study highlights the diverse range of family and fictive kin who participate in family caregiving for Latina breast cancer survivors. Spousal caregivers may not represent a unique population, whereas mothers as caregivers are indeed distinct for their higher distress levels.
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Banks I, Weller D, Ungan M, Selby P, Aapro M, Beishon M, Bolt M, Bonanno F, Champeix C, Dégi C, Eneqvist LJ, Kazmierska J, Kolacinska A, Malas S, Moine S, Pavlic DR, Price R, Walter F, Wyld L. ECCO Essential Requirements for Quality Cancer Care: Primary care. Crit Rev Oncol Hematol 2019; 142:187-199. [PMID: 31445441 DOI: 10.1016/j.critrevonc.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/03/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND ECCO Essential Requirements for Quality Cancer Care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to cancer patients. They are written by European experts representing all disciplines involved in cancer care. This paper concerns the integration of primary care into care for all cancers in Europe. Primary care integration.
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Affiliation(s)
- Ian Banks
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); European Men's Health Forum
| | - David Weller
- World Organization of Family Doctors (WONCA Europe); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mehmet Ungan
- World Organization of Family Doctors (WONCA Europe); Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Peter Selby
- European Cancer Concord (ECC); Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | - Matti Aapro
- European Cancer Organisation (ECCO); Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Marije Bolt
- Council of Occupational Therapists for European Countries (COTEC)
| | - Fiona Bonanno
- European Society of Oncology Pharmacy (ESOP); Sir Anthony Mamo Oncology Centre, Malta
| | | | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Lisa Jelf Eneqvist
- European Oncology Nursing Society (EONS); Regional Cancercenter Stockholm-Gotland, Sweden
| | - Joanna Kazmierska
- European Society of Radiotherapy and Oncology (ESTRO); Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland
| | - Agnieszka Kolacinska
- European Society of Surgical Oncology (ESSO); Department of Head and Neck Cancer Surgery and Surgical Oncology, Medical University of Lodz, Lodz, Poland
| | - Simon Malas
- Association of European Cancer Leagues (ECL); Oncology Clinic, Limassol General Hospital, Limassol, Cyprus
| | - Sébastien Moine
- European Association of Palliative Care (EAPC); Education and Health Practices Laboratory, University of Paris, France
| | | | | | - Fiona Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Lynda Wyld
- European Society of Breast Cancer Specialists (EUSOMA); Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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Given CW. Family Caregiving for Cancer Patients: the State of the Literature and a Direction for Research to Link the Informal and Formal Care Systems to Improve Quality and Outcomes. Semin Oncol Nurs 2019; 35:389-394. [PMID: 31229345 DOI: 10.1016/j.soncn.2019.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Based on recent shifts in reimbursement for cancer treatment from fee-for-service to bundled and value-based payment, this concluding article summarizes data from these papers and the large body of literature on caregiving to suggest how caregiving research might be redirected to link the formal with the informal systems to achieve higher-quality and lower-cost care. Caregiver dyads, the tasks of care, and strategies for training are presented. DATA SOURCES Articles in this issue of Seminars in Oncology Nursing, the larger body of caregiving literature, and the Oncology Care Model driving bundled payments and value-based care. CONCLUSION Research on informal caregiving for cancer patients should begin to reframe the rich body of evidence available toward a focus on caregivers reactions to the tasks of care, the training necessary for caregivers to perform them, and how each contributes to quality care at lower costs and appropriate outcomes given patients' stage of disease and goals of treatment. IMPLICATIONS FOR NURSING PRACTICE Oncology systems must take a more active role in including patients and their families as partners to manage treatments and side effects to achieve the best possible patient outcomes. They must be able to evaluate the patient and the caregiver to determine what tasks they will be able to perform, and then make sure they have the training and resources to carry out those tasks. Training could be done by social media and through communication using patient portals that could be expanded through the electronic medical records to include caregiver portals, enabling caregiver questions and reports of patients' conditions.
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Affiliation(s)
- Charles W Given
- College of Nursing, Michigan State University, East Lansing, MI.
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