Source of Social Support and Caregiving Self-Efficacy on Caregiver Burden and Patient's Quality of Life: A Path Analysis on Patients with Palliative Care Needs and Their Caregivers

The Impact of Social Support: Fathers' Depressive Symptoms and Parenting Stress

Parental depressive symptoms are positively correlated with levels of parenting stress. Greater parenting stress predicts negative outcomes for both parents and children, and worse family functioning. Social support is a key protective factor against depressive symptoms; however, minimal research has examined the relationship between social support, paternal depressive symptoms, and parenting stress among fathers. Seventy-nine fathers of children, aged 2-6 years old, completed an online survey. Mediation analyses, using Hayes' PROCESS macro, determined significant indirect effects of social support on parenting stress through paternal depressive symptoms. Our findings elucidate the need for social support from family, friends, and significant others to improve depressive symptomology and parenting stress among fathers. We encourage fathers to seek support from friends, family, and their partners, to benefit their mental health and the family unit. Clinicians working with fathers should be aware of the possibility of co-occurring problems related to these factors.

Does family confidence bridge child functioning and caregiver burden in early intervention?

BACKGROUND

Enhancing caregivers' confidence and competence in early childhood intervention is a priority, focusing on collaboration between professionals and families to improve family well-being and quality of life. Caregiver burden is crucial in early childhood intervention support services aimed at promoting family well-being and functioning. However, contextual factors and child-related variables may affect caregiver burden. We examined the relationships between family confidence, caregiver burden, and child functioning.

METHOD

A total of 169 Spanish families receiving early intervention services participated in a cross-sectional survey study. Data were analyzed applying single and multiple mediation analyses to examine the influence of socio-demographic variables on family confidence and caregiver burden, as well as the mediating role of family confidence between child functioning and caregiver burden.

RESULTS

The study found that child functioning does not directly impact caregiver burden but significantly influences it through family confidence. Confidence in helping the child was a relevant mediator of the impact of child functioning on caregiver burden. However, confidence in helping the family was a mediator across all dimensions of caregiver burden.

CONCLUSIONS

Higher family confidence predicts lower caregiver burden in early childhood intervention. Confidence in helping family functioning is key to mitigating the negative impact of child functioning on caregiver burden. Practical implications of these findings suggest that early childhood intervention services should focus on capacity-building through collaborative and family-centered practices, empowering families to enhance their confidence, and reduce caregiver burden.

Perceived Social Support, Intolerance of Uncertainty, and War-Related Stress: Unraveling the Nexus with Treatment Burden in Adult-Child Caregivers During War

Adult-child caregivers encounter various challenges due to their array of roles and tasks, often leading to a substantial sense of treatment burden. While previous research has explored factors contributing to treatment burden, much of it has centered on routine periods, leaving a gap in the understanding of this issue during crisis situations characterized by heightened stress and uncertainty. Therefore, this study aims to address this gap by investigating the mediating role of intolerance of uncertainty and war-related stress in the relationship between perceived social support and treatment burden among adult-child caregivers during the Israel-Hamas war. The study involved Israeli adult-child caregivers who completed a structured questionnaire distributed online. The findings showed that perceived social support was negatively associated with intolerance of uncertainty, which, in turn, was positively associated with war-related stress. Consequently, a positive correlation was observed between war-related stress and treatment burden. Perceived social support was found to be negatively associated with war-related stress. These findings underscore the significance of social support in reducing treatment burden, particularly during periods of heightened stress such as wartime. Understanding the interplay between these factors can inform the development of effective interventions aimed at alleviating the burden experienced by adult-child caregivers.

Stress, Employment Changes, and Psychological Distress Among Caregivers of Patients With Head and Neck Cancer

Importance

Patients undergoing external beam radiation therapy (EBRT) for head and neck cancer (HNC) often experience adverse effects that require substantial caregiving. The burdens of caregiving can impact caregiver employment and mental health over time, yet this topic remains underexplored.

Objective

To examine the associations between caregiving for patients with HNC who undergo EBRT and caregiver stress, employment status, and psychological distress.

Design, Setting, and Participants

This was a secondary analysis of data from a longitudinal survey study that surveyed caregivers at baseline (ie, at initiation of EBRT) and at 4-month and 12-month follow-ups. The study was conducted at 2 comprehensive cancer centers in Houston, Texas, and New York, New York, and included patients with HNC who had undergone EBRT and their caregivers. Data were collected from September 1, 2009, to August 31, 2014, and were analyzed from June 1, 2024, to August 31, 2024.

Main Outcomes and Measures

The primary outcomes included caregiver employment status and psychological distress level, the latter of which was measured using the Brief Symptom Inventory-18 (BSI-18) for general distress and the Impact of Event Scale-Revised (IES-R) for cancer-specific distress.

Results

The study included 188 caregivers, 159 (84.6%) of whom were female; the mean (SD) age for all caregivers was 54.6 (10.4) years. At baseline, 53 caregivers (28.2%) met BSI-18 criteria for general distress, and 85 (45.2%) met IES-R criteria for cancer-specific distress. By the 12-month follow-up, these rates decreased to 16 of 112 (14.3%) and 30 of 112 (26.8%), respectively. Caregivers were 40% less likely to be employed full-time at the 4-month follow-up (odds ratio, 0.60 [95% CI, 0.48-0.75]), and this reduction persisted with a 41% lower likelihood of full-time employment at the 12-month follow-up (odds ratio, 0.59 [95% CI, 0.47-0.74]). Caregivers who reduced their work hours or exited the workforce during the entire study period (n = 48 [25.5%]) reported higher levels of general distress (β = 4.02 [95% CI, 0.65-7.39]). Furthermore, greater role captivity (β = 5.37 [95% CI, 2.12-8.63]) and lower caregiving competence (β = -3.84 [95% CI, -6.21 to -1.47]) were associated with elevated levels of both general distress and cancer-specific distress.

Conclusions and Relevance

The findings of this survey study suggest that caregiving for patients with HNC undergoing EBRT may be associated with lower employment rates and poorer mental health among caregivers. Integrating caregivers into multidisciplinary HNC care to identify those at risk and connecting them to timely employment-based interventions such as flexible work arrangements and caregiver leave, as well as community-based support services such as counseling and social network-building, could help alleviate the dual burden of employment strain and psychological distress, benefiting both caregivers and patients.

Modeling Pathways by Which the Caregiver TLC Psychoeducational Program Affects Psychological Health of Caregivers

BACKGROUND AND OBJECTIVES

The study seeks to elucidate the pathways by which the Caregiver Thrive, Learn & Connect (TLC) psychoeducational program affects the psychological health of caregivers by examining the degree to which changes in self-efficacy, personal gains, and emotional support mediate the changes in perceived depression, anxiety, and burden.

RESEARCH DESIGN AND METHODS

Using pre-post data from the Caregiver TLC randomized controlled trial (n = 81) for each outcome and mediator pair, a series of multiple regression models were executed to test the degree to which the program's total effects on changes in depression, burden, and anxiety from baseline to post-intervention are due to changes in each mediator variable from pre- and post-intervention assessments. Caregivers were primarily female (85%), White (62%), and Black (38%), with a median age of 62 and household income of $75,000+. Caregivers reported caring for a person with dementia (69%) or chronic health conditions (31%).

RESULTS

Mediation path modeling indicated that changes in self-efficacy were affected by participation in the Caregiver TLC program, mediating between 32% and 63% of the total treatment effect on the outcome variables. Change in personal gains and change in emotional support also demonstrated meaningful mediation effects, albeit smaller in magnitude.

DISCUSSION AND IMPLICATIONS

Results confirm that the observed positive impact of the Caregiver TLC program is due to changes in self-efficacy (in particular) and to a lesser degree to changes in personal gains and emotional support. These results confirm that strengthening caregivers' perceived self-efficacy to manage stress plays a significant role in improving psychosocial functioning.

Factors affecting the caregiver burden of family members to palliative care patients: A descriptive and cross-sectional study

OBJECTIVES

Many factors affect caregiver burden. Limited studies exist on the effect of social support and fatigue on family caregivers. This study aims to explore the impact of fatigue and social support on the burden experienced by family caregivers of palliative care patients.

METHODS

The study was conducted with 80 family caregivers. Data were collected using the Piper Fatigue Scale, the Burden Interview, and the Multidimensional Scale of Perceived Social Support. Regression analysis was used to evaluate the data.

RESULTS

The regression analysis revealed that higher scores on the MSPSS were significantly associated with lower Burden Interview scores (p < 0.05). Conversely, higher PFS scores were significantly correlated with increased Burden Interview scores (p < 0.05).

DISCUSSION

Both fatigue and social support play a critical role in shaping the caregiving burden experienced by family caregivers. Interventions aimed at reducing caregiver fatigue and enhancing social support may help alleviate this burden.

Effects of virtual counseling on the care burden and quality of life of family caregivers for leukemia patients: a randomized controlled trial study

BACKGROUND

Leukemia patients' caregivers often face care burden and low quality of life. Continuous virtual counseling can help to management these problems. This study examines effects of virtual counseling on the care burden and quality of life of family caregivers for leukemia patients.

METHOD

The study employed a randomized controlled trial pretest-posttest design with a control group, involving 90 family caregivers of leukemia patients at Iranian oncology clinics in 2021. Two oncology clinics were randomly assigned as experimental (45 participants) and control groups (45 participants). Participants were recruited using a convenience sampling method, adhering to pre-defined inclusion criteria. Data collection was facilitated using Novak and Guest's Caregiver Burden Inventory and the Caregiver Quality of Life Index-Cancer, administered at baseline, one month, and two months post-intervention. The experimental group engaged in six weeks of continuous virtual counseling, with sessions lasting 45-60 min each week. In contrast, the control group received standard hospital care.

RESULTS

The average ages of the experimental and control groups were 34.29 and 32.33 years, respectively. In the experimental group, 51.1% were men, and 68.88% were spouses of patients. In the control group, 62.2% were women, and 44.45% were spouses of patients. Two months following the intervention, the experimental group demonstrated significant improvement in average scores for both care burden (experimental group: baseline: 90.11 ± 11.34, post-test 1: 73.78 ± 11.58, post-test 2: 52.91 ± 13.57; control group: baseline: 86.38 ± 9.81, post-test 1: 90.93 ± 14.54, post-test 2: 97.40 ± 15.03; a large significant interaction effect for time*group (η2 = 0.653, p < 0.001), and quality of life (baseline: 65.18 ± 8.36, post-test 1: 73.76 ± 6.53, post-test 2: 89.07 ± 9.43; control group: baseline: 61.82 ± 11.68, post-test 1: 51.96 ± 11.22, post-test 2: 44.24 ± 13.63; a large significant interaction effect for time*group (η2 = 0.651, p < 0.001).

CONCLUSION

The findings of this study suggest that virtual counseling can be a positive influence in reducing care burden and improving the quality of life for caregivers of leukemia patients. These results highlight the potential value of incorporating virtual counseling strategies into the caregiving support programs for nurses.

TRIAL REGISTRATION

Current controlled trials IRCT20211227053551N7) on February 9, 2025, as well as Retrospectively registered.

Family Caregivers' Perceptions and Experiences of Supporting Older People to Cope With Loneliness: A Qualitative Interview Study

Loneliness has become a significant public health issue among community-dwelling older adults particularly those with multimorbidity. Family caregivers are crucial care resources for dependent older adults living in the community before transitioning to institutional services. However, understanding of their perceptions in supporting older adults with multimorbidity to cope with loneliness is limited. This qualitative study aimed to elucidate on the experiences of caring and explore the experiences and perceptions of family caregivers in supporting older community-dwelling adults with multimorbidity to cope with loneliness. Eleven family caregivers, aged 51-93 years old, with at least 2 years of caregiving experience were purposively recruited and interviewed individually. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was utilised to report the study. Three key themes were generated from the inductive analysis: (1) recognising older adults' loneliness through the expression of unusual emotions, behaviour/s, social network alteration and speech; (2) variations in perceptions and responses to loneliness among different family caregiving relationships; and (3) challenges in addressing loneliness. Positive feedback from cared-for older adults was appreciated by their family caregivers which in turn motivated further actions to alleviate loneliness. The findings emphasised the importance of developing specific patients and family caregivers centred interventions, such as communication skills training to enhance effective communications. Cultural values and norms of individuals should be respected in those interventions, ensuring that emotional expression is facilitated in a comfortable way for both older patients and family caregivers.

Depression, anxiety, stress and related factors among husbands of Iranian women with cancer: A cross-sectional study

PURPOSE

The aim of this study was to determine the prevalence of depression, anxiety, and stress and their related factors in husbands of women with cancer.

METHODS

This cross-sectional study included 400 husbands of women with cancer who referred to two cancer referral centers in Kashan (Isfahan, Iran) from April to August 2022. The demographic and medical data, the Larson Satisfaction Questionnaire (LSQ), and the Depression, Anxiety, Stress Scale-21 (DASS-21) were collected.

RESULTS

The mean age of the husbands was 50.47 ± 10.16 years, and the prevalence of depression, anxiety, and stress was 15%, 17.5%, and 17.8%, respectively. Multiple regression analysis revealed significant associations between husbands' depression and age, involvement rate in caring for their wife, sexual satisfaction, and education level (p < 0.05). The rate of anxiety was also related to education level, economic status, housing status, the rate of involvement in caring for one's wife, sexual satisfaction, the duration of the woman's cancer, the degree of cancer progression, and the length of hospitalization due to cancer (p < 0.05). The stress rate also showed a significant correlation with age, educational level, degree of involvement in caring for one's wife, and duration of cancer (p < 0.05).

CONCLUSION

The prevalence of psychological problems among husbands of women with cancer is remarkable. Therefore, based on the identified factors associated with these complications, supportive care programs can designed by health care professionals to improve mental health and reduce the suffering of husbands of patients with cancer.

Effectiveness of technology-based psychosocial interventions for improving health-related outcomes of family caregivers of stroke survivors: A systematic review and meta-analysis

AIM

To synthesize evidence regarding the effectiveness of technology-based psychosocial interventions in improving health-related outcomes among family caregivers of stroke survivors.

DESIGN

A systematic review and meta-analysis was reported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Randomized controlled trials that investigated the effects of psychosocial interventions delivered through information and communication technologies on self-efficacy, caregiving competence, caregiver burden, perceived social support, anxiety, depression, health-related quality of life and cost-effectiveness were included. Two researchers independently selected studies, extracted data, and appraised the quality of the included studies. Subgroup analysis, sensitivity analysis, and narrative synthesis were conducted.

DATA SOURCES

Ten electronic databases (PubMed, CENTRAL, Web of Science, Scopus, CINHAL, Embase, Institution of Electrical Engineers Xplore, Ovid Medline, PsycINFO, ProQuest Dissertations and Thesis) were searched up to February 2023.

RESULTS

Nineteen studies involving 1717 participants fulfilled the eligibility criteria. Technology-based psychosocial interventions significantly improved self-efficacy (SMD = .62), caregiving competence (SMD = .55), depression (SMD = -.25) and anxiety (SMD = -.35). However, perceived social support, caregiver burden, and health-related quality of life did not show significant improvements. Subgroup analyses revealed that the interventions, lasting from 4 to 6 weeks and encompassing comprehensive contents, exhibited larger effect sizes. None of the studies measured cost-effectiveness.

CONCLUSION

The technology-based psychosocial interventions are effective in enhancing self-efficacy and caregiving competence, as well as alleviating anxiety, and depression among family caregivers of stroke survivors. Future research should investigate interventions delivered through various digital platforms using well-designed RCTs with in-depth qualitative data collection and measurement of health and cost-effectiveness outcomes.

IMPACT

Through psychosocial interventions, healthcare providers in clinical and community settings, particularly nurses, could incorporate technologies into current stroke care practices.

PATIENT OR PUBLIC CONTRIBUTION

It is not applicable as this is a systematic review.

REGISTRATION

The protocol was registered on PROSPERO (CRD42023402871).

Caregiving burden, social support, and psychological well-being among family caregivers of older Italians: a cross-sectional study

Objectives

This study aimed to identify factors affecting the psychological well-being of family caregivers of dependent older adults in Italy. Understanding these variables is essential for designing interventions to prevent negative outcomes in at-risk caregivers. The research explored how varying levels of caregiving burden and types of perceived social support influence psychological well-being.

Methods

A cross-sectional study was conducted among 387 family caregivers of older adults in the Marche region (Italy) between November 2019 and March 2020. Data were collected via a structured questionnaire assessing psychological well-being (WHO-5 Well-Being Index), caregiving burden, and social support (COPE Index). Statistical analyses were performed using Jamovi software, with a significance threshold set at p < 0.05.

Results

A significant negative correlation was found between caregiving burden and psychological well-being [r (364) = - 0.540, p < 0.001], with caregiving burden being a significant predictor of psychological well-being reduction (R 2 = 0.290; F = 150, p < 0.001). A threshold value of 2 (on a 1-4 scale) was identified, where caregiving burden predicted a significant reduction in psychological well-being. Conversely, greater perceived social support was positively correlated with better psychological well-being [r (357) = 0.348, p < 0.001] and was a significant predictor of it [R 2 = 0.121; F = 49.2, p < 0.001]. Support from social and health services had the most notable impact on psychological well-being. Moreover, social support mitigated the negative impact of caregiving burden on psychological well-being.

Conclusion

The study confirms that high caregiving burden adversely affects caregivers' psychological well-being, while social support plays a protective role. These findings highlight the need for interventions focused on reducing caregiving burden and enhancing support systems for family caregivers.

Barriers and Facilitators of Palliative Care in Older Adults With Heart Failure: A Qualitative Content Analysis

Objectives: The progressive and unpredictable course of heart failure (HF) has made the provision of palliative care (PC) services to older adults with HF a serious challenge. This study aimed to explain the barriers and facilitators of PC in older adults with HF. Methods: This qualitative study was conducted using the content analysis approach. A sample of 15 participants, including 6 patients, 2 family caregivers, and 7 healthcare team members (4 nurses, a psychiatric nurse, a nutritionist, and a PC physician) were selected by purposive sampling over 10 months (November 21, 2020 to September 1, 2021). The data were collected using semistructured in-person interviews until data saturation and analyzed with conventional qualitative content analysis. Results: The findings revealed the main category of "neglecting the provision of PC," with 4 subcategories of "weak organizational structure," "poor social support," "older adults' and healthcare teams' poor knowledge," and "limited financial resources" as the barriers of PC and the main category of "enjoying support potentials" with 3 subcategories of "the cooperation of the government, benefactors, and nongovernmental organizations," "empathy from the family and relatives," and "benefiting from the presence of healthcare workers" as PC facilitators. Conclusions: The findings of this study explained the barriers and facilitators of PC in older adults with HF. Removing the barriers and supporting the facilitators give older adults with HF better access to PC. Therefore, to expand PC centers for older adults with HF, health system officials, and policy-makers should pay attention to organizational infrastructures and remove the barriers at organizational, social, educational, and economic levels with the cooperation of governmental organizations, benefactors, and nongovernmental organizations.

Nurse Telephone Support for Caregivers of Older Adults at Hospital Discharge: A Randomized Clinical Trial

Importance

Informal caregivers who provide home-based care frequently experience stress and burden that adversely affect their health-related quality of life (HRQOL).

Objective

To evaluate the efficacy of the Further Enabling Care at Home (FECH+) program for the HRQOL of caregivers of older adults discharged home from the hospital.

Design, Setting, and Participants

This multicenter, parallel, 2-group randomized clinical trial, with blinded baseline and outcome measurements, was conducted at 3 hospitals in 2 states in Australia. Recruitment took place between August 2020 and July 2022, and follow-up was performed for 12 months after hospital discharge. Participants were dyads of caregivers and patients. Eligible caregivers were aged 18 years or older who provided informal home-based care at least weekly for a patient aged 70 years or older. Caregivers were enrolled when their patient was discharged from the hospital. Dyads were randomly assigned to either the intervention or control group. Data analysis followed an intention-to-treat approach.

Intervention

Caregivers in the intervention group received the FECH+ program, structured nurse support of 6 telephone calls over 6 months after the patient's discharge plus usual discharge care. Caregivers in the control group received usual care alone.

Main Outcomes and Measures

Primary outcome was caregivers' HRQOL 6 months after discharge, which was measured using the Assessment of Quality of Life 8-Dimension (AQOL-8D). Secondary outcomes were caregivers' HRQOL 12 months after discharge as well as preparedness to care (measured using the Preparedness for Caregiving Scale), self-efficacy (measured using the Caregiver Inventory), and levels of strain and distress (measured using the Family Appraisal of Caregiving Questionnaire) at 6 and 12 months after discharge. Baseline and outcome measurements were administered by telephone at 3, 6, and 12 months after discharge.

Results

A total of 547 dyads (caregivers: 405 females [74.0%], mean [SD] age, 64.50 [12.82] years; patients: 296 females [54.1%], mean [SD] age, 83.16 [7.04] years for the intervention group and 83.45 [7.20] years for the control group) were included in the intention-to-treat analysis. There was no significant difference in caregivers' HRQOL between the 2 groups at the primary time point of 6 months (difference in AQOL-8D score, 0.01; 95% CI, -0.02 to 0.03; P = .62) after hospital discharge.

Conclusions and Relevance

In this randomized clinical trial, the FECH+ program-a nurse telephone support intervention for caregivers of older adults after hospital discharge-did not significantly improve caregivers' HRQOL at 6 months after discharge compared with usual care. Additional examination is warranted into improving caregivers' HRQOL at the time of their patient's hospital discharge.

Trial Registration

Australian New Zealand Clinical Trials Registry Identifier: ACTRN12620000060943.

Caregiving Outcomes of Sub/Urban and Rural Caregivers: The Powerful Tools for Caregivers Program

OBJECTIVES

The research aimed to investigate the effectiveness of the Powerful Tools for Caregivers (PTC) program for rural caregivers.

METHODS

A total of 160 caregivers participated in the program. Exploratory factor analysis was performed to identify latent caregiving outcomes. Paired samples t-tests were conducted to investigate changes in caregiving outcomes before and after the program. To examine geographical differences in the caregiving outcomes, independent samples t-tests were performed. Qualitative responses of the participants were also analyzed.

RESULTS

Self-care and positive coping strategies were identified as latent caregiving outcomes. When comparing these two outcome scores before and after the program, the scores significantly improved. The changes in the caregiving outcomes of rural caregivers were greater than those of sub/urban caregivers. Although rural and sub/urban caregivers qualitatively reported similar themes, there were geographical differences in the percentages of caregivers reporting each theme.

CONCLUSIONS

The PTC program was effective in improving self-care and positive coping strategies, but the effect of the program was more pronounced in rural areas. Our findings suggest that interventions focusing on self-care and positive coping strategies may beneficially impact rural caregivers.

CLINICAL IMPLICATIONS

The PTC program appears promising to improve self-care strategies and enhance self-efficacy of rural caregivers.

Nurse-led proactive mobile application in symptom management for children with medical complexity: Study protocol for a randomized controlled trial

AIM

To investigate the effect of a nurse support using a proactive mobile app to enhance parental self-efficacy in symptom management for children with medical complexity.

DESIGN

A single-blinded, randomized controlled trial with a two-armed repeated measures design.

METHODS

Eligible parents and the children will be recruited from the special schools and non-government offices. They will be randomly assigned either to the intervention or control groups. Subjects in the study group will receive nurse parental support using a symptom management mobile app for 3 months. The control group will receive the usual care that is available in the community. Data will be collected pre-intervention (T1), immediately after the intervention (T2), and three-month after intervention (T3). The primary outcome is parental self-efficacy. The secondary outcomes include child's symptom burden and their health service utilization. Primary outcome will be compared across two groups in T2 and T3 using with control for the pre-test value of parental self-efficacy. Generalized estimating equation (GEE) will be used to address secondary objectives from T1 to T3 with appropriate link function.

DISCUSSION

As a result of the successful implementation of this nurse-led symptom management, parental self-efficacy will be enhanced. Both the symptoms reported by the children and their health service utilization will be reduced. Findings of this study will help in service delivery improvements because it maximizes the availability and accessibility of paediatric health service to parents and the children in local communities.

IMPACT

The evidence produced in this study will enlarge the knowledge base that supports evidence-based paediatric home nursing service with the use of health technology in symptom management. This evidence will also contribute to the development of other symptom management programs for other paediatric patient groups.

TRIAL REGISTRATION

NCT05765643 (ClinicalTrials.gov identifier).

PATIENT OR PUBLIC CONTRIBUTION

Parents of children with medical complexity contributed in mobile application development by giving comments on the usability of mobile application.

IMPACT WILL BE GENERATED THROUGH THE FOLLOWING BENEFITS

Improve health service delivery: Home nursing service may not be sustainable in a long run in Hong Kong, as the health care system has been facing a serious nursing workforce shortage in recent years. Besides, these services are affected or even suspended during the community outbreak of infectious disease, like recent coronavirus disease pandemic. Nurse parental support in symptom management for the CMC using a proactive mobile health application will help in service delivery improvements because it maximizes the availability and accessibility of paediatric health service to parents and their CMC in local communities. Improve physical and psychological health of parents and their CMC: The success of program implementation will help to increase parental self-efficacy in symptom management for their CMC, as a result of decrease of children's symptom burden. Improve knowledge base: The evidence produced in this study will (1) enlarge the knowledge base that supports evidence-based paediatric community nursing service related to symptom management for the CMC. This evidence will contribute to the development of other symptom management programs for other paediatric patient groups.

Perceived social support and quality of life in endometrial cancer patients: a longitudinal study

Objective

This study aimed to assess the influence of medical history, perceived physician-patient communication, and perceived social support on changes in the quality of life (QoL) during the first year of follow-up in patients undergoing surgery for endometrial cancer (EC), the most prevalent gynecological cancer in Western countries, especially in Central and Eastern Europe and North America.

Methods

This prospective longitudinal study included 98 EC patients. All participants completed the Short Form 36 (SF-36) and the Multidimensional Scale of Perceived Social Support (MSPSS) one month and one year after surgery. Additionally, one month after surgery, they responded to a questionnaire designed by the researchers concerning the key aspects of physician-patient communication.

Results

Our findings revealed that patients reporting high social support one month after surgery demonstrated significantly improved emotional well-being (EWB) at both one month and one year after the surgery, with statistically significant higher scores in the dimension of EWB (p<0.05). The support from a significant other at one year correlates with greater PF (p<0.005), fewer limitations due to physical health (p<0.05), less pain (p<0.05), less fatigue (p<0.05), and better general and EWB (p<0.05).

Conclusion

This study underscores the significance of perceived social support for patients cross endometrial cancer. The multifaceted nature of social support, encompassing emotional assistance and information sharing, emerges as a pivotal factor aiding patients in confronting the challenges inherent to EC. This form of support contributes to bolstering psychological well-being and enhancing overall QoL.

Caregiver Burden and Family Quality of Life in Early Intervention: The Role of Mothers and Family Confidence

(1) Background: Because life events when there is a family member with a disability can affect the overall family wellbeing, contributing to enhance family quality of life (FQoL) in the field of early childhood intervention has become a priority. However, it is a distal outcome that needs other short-term outcomes to be addressed, some of them under the potential impact of support services. This study examines the relationships between caregiver burden, family confidence, and FQoL, as well as the influence of child and family variables. (2) Method: A total of 58 families with children in early intervention from four Spanish communities participated. Hierarchical regression was conducted to assess the relevance of each predictor. Also, a mediation was performed to investigate the mediating role of family confidence. (3) Results: The family income impacted FQoL scores, and when burden and confidence were added, it was no longer relevant. Mothers with higher levels of confidence predicted a higher FQoL. Finally, we found a complete mediation of family confidence in the relations between severity and caregiver burden on FQoL. (4) Conclusions: Caregiver burden and family confidence affect FQoL. Building families' confidence contributes to attenuating the impact of burden on FQoL.

Emotional Support from Care Recipients, Caring Relationship Quality, and Caregiving Self-Efficacy among Family Caregivers of Older Adults

We analyzed 756 family caregivers (mean age = 62.3 years), investigating how emotional support from older care recipients was linked to caregivers' self-efficacy through caring relationship qualtiy. Results indicate a significant positive association between emotional support and caregivers' self-efficacy (r = 0.207, p < .01). Caring relationship quality positively correlated with emotional support (r = 0.292, p < .01) and caregivers' self-efficacy (r = 0.141, p < .01). Controlling for socialdemographic and care-related factors, relationship quality partially mediated the association between emotional support from care recipients and caregivers' self-efficacy. This suggests that interventions supporting caregivers' self-efficacy may benefit from considering both care recipients and dyadic relationships.

Songwriting Group Music Therapy to promote psychological adjustment in informal caregivers of elderly people with dependency: a mixed methods study

Introduction

Informal caregivers of elderly people with dependency (EPD) provide intensive care that can affect their quality of life (QoL). Psychosocial interventions such as music therapy are important to work on their self-care. The aim of this study is to analyze, with a mixed method approach, the experience of participating in a Songwriting Group Music Therapy (SGMT) intervention on informal caregivers of EPD.

Methods

A total of 11 groups, with a convenience sample of 61 caregivers, received 10 SGMT sessions. Quantitative information related to QoL variables (anxiety, depression, spirituality, burden, and coping) was collected before and after the intervention and at 3 months of follow-up. Regarding qualitative data, an open-ended question about the experience of participating was asked.

Results

Significant changes were shown, sustained over time, in trait anxiety and depression and subscales including inner peace, social functioning, and mental health. Three themes were generated from the thematic analysis, including that SGMT participation can enhance personal growth, bring out and enable work on emotions, and promote helpful interpersonal dynamics.

Discussion

The findings indicate that SGMT is a useful intervention for informal caregivers of EPD, promoting psychological adjustment, enhanced coping, emotional regulation, and social support. This study reinforces the findings with caregivers of other populations, providing new results and highlighting the benefits of SGMT for caregivers of EPD.

Social capital for carers of patients with advanced organ failure: a qualitative exploration of stakeholders' perspectives

BACKGROUND

Carers of patients with advanced organ failure (AOF) experience a tremendous caregiving burden. Social capital utilizes the internal strength of a community to support its members and may provide carers with comprehensive support. This study aimed to identify the different sources of social capital that can support carers of patients with AOF from the perspectives of stakeholders.

METHOD

A descriptive qualitative study was conducted in community settings from April 2021 to May 2022. Stakeholders from medical social work departments, self-help groups, and non-governmental organizations were recruited, while some community members were invited through online media platforms. Individual semi-structured interviews were conducted using an interview guide. Interview transcripts were analyzed using a qualitative description approach. In total, 98 stakeholders, including 25 carers, 25 patients, 24 professionals, and 24 community members, were recruited using purposive and snowball sampling.

RESULTS

Six categories about social capital for carers emerged, namely, carer attributes, the community, social care services, healthcare services, information, and policies. While the attributes of carers and their relationships with care recipients had a significant influence on caregiving, support from different groups in the community, such as neighbors and employers, was valued. Good communication of information about caregiving and social services was emphasized as being helpful by carers and other stakeholders. While carers presented a need for various healthcare and social care services, several features of these services, including their person-centeredness and proactive reach, were deemed useful. At the societal level, policies and research on comprehensive supportive services are warranted. The different sources of social capital constitute a multi-layer support system in the community.

CONCLUSION

Carers can utilize personal attributes, interpersonal relationships, community resources, and societal contexts to enhance their caregiving. While this system can serve as a framework for building carer-friendly communities, interventions may be required to strengthen some aspects of social capital.

The Caregiving Burden of Older People with Functional Deficits and Associated Factors on Malaysian Family Caregivers

Background

Providing care to older people can be an extremely complex task, given their increased functional deficits, which may lead to family caregivers experiencing burnout and a deteriorated health status. This study investigated the caregiving burden of older people with functional deficits on family caregivers and associated factors.

Methods

This cross-sectional study was conducted on family caregivers of older people with functional deficits living in FELDA schemes in Pahang, Malaysia. A self-administered questionnaire was used to collect data, which included the sociodemographical profile, health status and caregiving demands factors. The caregiving burden was assessed using the Malay version of the Zarit Burden Interview (ZBI). Multiple linear regression was used to assess the factors associated with burden.

Results

A total of 271 family caregivers completed the questionnaire. Their mean age was 45.8 (SD 0.9) years old. The mean score for caregiving burden was 18.5 (SD 13.6). Caregivers' gender (3.5 [95% CI: 0.2, 6.8]; P = 0.037), older people with chronic disease (9.6 [95% CI: 2.4, 16.9]; P = 0.010) and the functional independence of older people (-1.1 [95% CI: -1.6, -0.6]; P < 0.001) were predictors of family caregiving burden.

Conclusion

The caregiving burden among family caregivers was mild and influenced mainly by care recipients' health status. A proper assessment should be conducted and relevant health education provided to prepare family caregivers to care for their family members before discharge from the hospital.

Effect of a supportive-educational program, based on COPE model, on quality of life and caregiver burden of family caregivers of heart failure patients: a randomized clinical trial study

BACKGROUND

Heart failure (HF) is one of the most common and spreading diseases worldwide. As HF symptoms progress, it is affected the quality of life and the caregiver burden of the family. The present study aimed to determine the effectiveness of the supportive-educational program, based on the COPE (creativity, optimism, planning and expert advice) care model, on the quality of life and caregiver burden of family caregivers of HF patients.

METHOD

This clinical trial was conducted on 90 caregivers of HF patients admitted to Isfahan in 2021. The samples were divided into experimental (n = 45 people) and control (n = 45 people) groups based on random allocation (card method). The experimental group received problem-solving skills based on the four components of the COPE model in six sessions during one month. to collect data, the 36-Item Short Form Survey (SF-36) and the Zarit Burden Interview (ZBI) were used in two groups before, after and three months after the intervention.

RESULTS

There was a significant difference between the experimental and control groups regarding gender, but This confounding factor had no significant effect on the two components of quality of life and caregiver burden. There was a significant difference between the two groups in terms of the mean score of quality of life immediately(75.99),and three months after the intervention (78.78) (P < 0.05) and the mean score of care burden, immediately (16.60) and three months after the intervention (12.73) (P < 0.05).

CONCLUSIONS

One of the important duties of nurses is to implement educational-supportive programs for patients after the discharge of patients, These programs are family-oriented remotely for their caregivers.

TRIAL REGISTRATION

This study was registered by the Iranian Registry of Clinical Trials with decree code: IRCT20211128053202N1on 2022-02-20.

Call for special attention to the caregiver burden of patients with drug-resistant tuberculosis in low- and middle-income countries

The tuberculosis (TB)-related caregiver burden (CB), and particularly the multidrug and extensively drug-resistant tuberculosis (M/XDR-TB)-related CB, is not rare in caregivers caring for TB patients, especially when a family member is the caregiver. However, the existing studies on this topic are insufficient. This study briefly summarized the risk factors for the imposition of a TB-related CB and reasons why caregivers for patients with M/XDR-TB are more susceptible to a CB. We propose that special measures should be implemented to alleviate the TB-related CB based on our clinical experience and insights from China. This may improve the situation of caregivers for TB patients and ultimately improve the quality of life of TB patients.

Factors influencing cancer patients' caregivers' burden and quality of life: An integrative review

This integrative review assessed the factors influencing cancer patients' caregivers' burden and quality of life (QoL). Relevant studies were retrieved from five electronic databases and screened. After systematic screening by title, abstract, and full text, the review included 15 studies published between 2000 and 2022 and used an interpretive thematic synthesis design for analysis. Age (older), sex (male), high work requirements, relationships with patients, low-income levels, high subjective stress, patient dependency level, and trait anxiety were significantly associated with higher caregiver burden. Factors associated with the low QoL of caregivers were age (less than 35 years), caregiving role (more responsibility), relationship with patients (first-degree relative), low income, living in the same home with the patient, and higher social and family responsibilities. A moderate negative correlation (n = 6) was identified between the sum of the QoL scores and the burden. Future research should be integrated into identifying appropriate means to support caregivers of patients with chronic diseases, including cancer by segregating interventions to target specific caregiver populations.

Caregiving Self-Efficacy in Family Caregivers of People with Dementia: The Role of Knowledge of Dementia and Perceived Social Support

PURPOSE

To examine the role of perceived social support and knowledge of dementia in family caregivers of people with dementia (PwD) regarding caregiving self-efficacy.

DESIGN

Descriptive, cross-sectional, and predictive design was used.

METHODS

The study was conducted with caregivers of PwD (n:102) between March and May 2022. Data was collected using the following forms: a socio-demographic characteristics form, the revised scale for caregiving self-efficacy (RSCSE), the dementia knowledge assessment scale (DKAS) and the revised form of the multidimensional scale of perceived social support (RFMSPSS). Data was assessed through descriptive statistics and multivariate regression analysis.

FINDINGS

The participants' RSCSE, DKAS and RFMSPSS mean scores were 1125.89 ± 417.18 (range:0-1800), 15.70 ± 6.06 (range:0-34), and 52.72 ± 20.07 (range:12-74), respectively. Analysis indicated that DKAS and RFMSPSS predicted positive caregiving self-efficacy scores but it was not statistically significant for DKAS (R2:0.209, F:13.077, p < 0.001). These variables accounted for 21% of total variance of caregiving self-efficacy. RFMSPSS predicted positively and statistically significantly (β:0.461, p < 0.001) the total score of the self-efficacy scale.

CONCLUSIONS

The perceived social support of caregivers of PwD is an important predictor of the self-efficacy level of caregivers.

CLINICAL EVIDENCE

In order to enhance improving the quality of the caregiving process, caregivers should be strengthened, and caregiving self-efficacy should be comprehensively evaluated to enable assistance to the caregiver. The social support of caregivers is an important predictor of caregiving self-efficacy. Therefore, social support should be taken into consideration when engaging in appropriate initiatives.

Evaluating the role of social media in providing support for family caregivers of individuals with spinal cord injury

STUDY DESIGN

Quantitative study.

OBJECTIVES

The study aimed to explore Family Caregivers of Individuals with Spinal Cord Injury (FC-SCI) social media use patterns, most frequently used platforms, importance of social media for receiving and providing support, and type of social support (i.e., social companionship, emotional support, informational support) that FC-SCI receive or provide online.

SETTING

FC-SCI participants from Canada and USA.

METHODS

FC-SCI responded to measures regarding the social media platforms they use to access support, the importance of each platform, and the types of online social support they access through social media.

RESULTS

Sample consisted of 115 FC-SCI. Most caregivers were a partner or spouse of the individual with SCI (n = 110) and female (n = 111). Majority of FC-SCI spent 1-3 h daily on social media (n = 74), and Facebook was used predominantly (n = 108), followed by Instagram (n = 92), and YouTube (n = 66). For receiving or providing support, Facebook was ranked most important (60%), followed by Instagram (26%) and YouTube (17%). The mean differences and standard deviation were found for the types of social support: emotional support (25.93 ± 7.60), social companionship (23.85 ± 7.46), and informational support (27.24 ± 7.50).

CONCLUSIONS

Using social media for informational support is desired by FC-SCI as it is easily accessible, and time-efficient. The prevalent use of social media for support by FC-SCI demonstrates that social media is a valued platform for support. The support benefits for the mental and physical health of caregivers should be further evaluated.

Requirements for promoting help-seeking behaviors in family caregivers of cancer patients: A qualitative study

BACKGROUND

Caring for a family member with cancer is a challenging issue for families. Family caregivers often need the help of supportive resources to solve problems in their care role. A deep understanding of the requirements of caregivers to seek help is an effective step toward their ability to use supportive resources. This study aimed to identify and describe the requirements for promoting help-seeking behaviors in Iranian family caregivers of cancer patients.

MATERIALS AND METHODS

This qualitative study was conducted through in-depth semi-structured interviews with 28 participants selected using purposeful sampling method from 2019 to 2021. An interview guide with general questions about seeking help was used to maintain coherence in data collection. The interviews continued until data saturation. All interviews were recorded, transcribed and analyzed through qualitative content analysis.

RESULTS

The requirements of promoting help-seeking behaviors in family caregivers were grouped into four main categories: (1) improving social paths toward seeking help, (2) spiritual-psychological-cognitive empowerment toward seeking help, (3) strengthening the motivations behind seeking help, and (4) modifying the perception of cultural barriers to seeking help.

CONCLUSION

According to the results of this study, it is expected that by identifying the requirements of caregivers for seeking help and by health stakeholders designing comprehensive programs to address these needs, caregivers will be empowered to use supportive resources and provide a better care role.

Social support and associated factors among family caregivers of older people in North-East Peninsular Malaysia

Background

The negative health results associated with the family caregivers of older people can be alleviated with social support, which is considered a valuable resource. Hence, the factors contributing to social support need to be understood.

Objective

This study aimed to evaluate the social support associated with the family caregivers of older people.

Methods

A cross-sectional study was conducted among 231 family caregivers of older people conveniently selected from two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. Data were gathered between June to December 2021 using a Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire. Descriptive statistics were used to summarize the data in frequencies and percentages. Independent t-test and one-way analysis of variance were used to examine correlations among variables.

Results

The mean scores of social support for family caregivers were significantly higher among their family (Mean ± SD; 5.44 ± 0.969) and other important people (5.25 ± 1.123) compared to their friends (4.84 ± 1.094). Caregivers' gender and duration of caregiving were significant factors associated with social support (p <0.05).

Conclusions

The family caregivers received maximum support from their family and other important people, but they were less supported by their friends. This study also observed that the perceived social support of the caregivers of older people was affected by several factors, such as gender and duration of caregiving. This finding gives nurses and other healthcare workers the basic information they need to enhance nursing interventions and promote social support among those who care for older people, which can positively impact caregiving.

Perceived social support and family members of patients with mental disorders: A mixed method study

INTRODUCTION

Family members are the caregivers to patients with mental disorders at home, and the mental and spiritual pressures caused by this responsibility necessitate physical, mental, and perceived social support for these families. The present mixed method study is an attempt to elaborate on the perceived social support by Iranian families of patients with chronic mental disorders.

MATERIALS AND METHODS

Using a sequential mixed method explanatory study (quantitative and qualitative), 200 family members of patients with chronic mental disorders were selected through convenient sampling (quantitative phase). Data gathering was started using a demographics form and Stewart and Sherburne's perceived social support scale. The qualitative phase included 10 participants who obtained low scores in the quantitative phase and took part in private, face-to-face, in-depth, and semi-structured interviews. The data obtained in the quantitative phase were analyzed using statistical tests, and the interviews were analyzed using qualitative content analysis.

FINDINGS

The perceived social support by the participants was at a moderate level in different fields of tangible support, information and emotional support, kindness, and positive social interactions. The results of the qualitative phase revealed social support status in 15 subcategories, 6 categories, and 2 themes of support and acceptance by family, relatives, and friends, with support and being understood by society. The results of the qualitative and quantitative sections emphasized the needs of the patient's family members (who acted as caregivers for patients) for support in family, social, and emotional areas.

CONCLUSION

The family members of patients with chronic mental disorders have different needs in the area of perceived social support. Such needs are more tangible in family members such as children with mentally ill parents or parents with mentally ill children. The results of this study can be used for educational and supportive planning for caregivers of patients, most of whom are family members.

Caregiving burden and social support in family caregivers of patients with cancer: A cross-sectional study

Introduction

Providing care for patients by family caregivers causes in several consequences known as “Caregiving Burden”, which affects the caregiver's health and the whole family process, considered in holistic healthcare/nursing. This study aimed to evaluate the caregiving burden and social support in family caregivers of patients with cancer and their influencing factors in a local area in Iran.

Methods

In this cross-sectional study, 190 family members of patients with cancer were studied through convenient sampling method. Data were collected using demographic data sheet enriched with Karnofsky Performance Status Scale and Katz Index of Independence in Activities of Daily Living (ADL), and Zarit Burden Inventory and Medical Outcomes Social Support Survey questionnaires.

Results

The results indicated intermediate performance status and moderate independence in ADL in patients. The mean score of caregiving burden was 43.95 ± 17.48 which indicates moderate to severe burden. The average social support in the caregivers was 60.25 ± 23.81% which shows above the average social support. Both performance status and dependence in ADL of patient had statistically significant effect on the caregiving burden in caregivers. Also a statistically significant negative relationship was observed between caregiving burden and social support in primary family caregivers of patients with cancer.

Discussion

Considering the increasing importance of primary care provided by families, developing strategies for providing caregiver's needs through family care in cancer nursing is essential. So supporting caregivers through family nursing in holistic healthcare by providing social support, can play a significant role in reducing caregiving burden in healthcare services considering the qualified holistic healthcare/nursing.

Technology-Delivered Motivational Interviewing to Improve Health Outcomes in Patients with Chronic Conditions. A Systematic Review of the Literature

AIM

Provide an overview of remote Motivational Interviewing (MI) interventions for chronically-ill patients, and understand their degree of effectiveness on different health outcomes.

METHODS AND RESULTS

A systematic review with meta-analysis was conducted using the following databases: PubMed, CINAHL, PsychInfo, and Web of Science. Eligibility criteria included studies that administered remote MI alone or in combination with other remote approaches. A narrative synthesis and two meta-analyses were performed. Fifteen studies met the inclusion criteria. MI administration almost exclusively occurred by telephone and individual sessions. Eight studies reported treatment fidelity aspects, and four declared adopting a theoretical framework. Most targeted outcomes were therapeutic adherence, physical activity, depression, quality of life, and mortality. Risk of bias varied markedly, with the largest source resulting from selection process and intervention performance. The two meta-analyses indicated a significant effect of MI on depression (Standardized Mean Difference = -0.20, 95%CI: -0.34, -0.05, Z = 2.73, p = 0.006, I2 = 0%), and no effect of MI on glycosylated hemoglobin (Mean Difference = -0.02, 95%CI: -0.48, 0.45), p = 0.94, I2 = 84%).

CONCLUSION

Remote MI can be a promising approach for improving depression in chronic disease patients. However, studies are inconclusive due to risks of bias, heterogeneity, and lack of reporting of interventionist's training, treatment fidelity, and theoretical frameworks' use. More studies with solid designs are needed to inform clinical decision-making and research.

Home care practices of cancer caregivers and the effect of perceived social support on care burden

INTRODUCTION

Caregivers have to manage tasks at home such as providing management of the patient's follow-up. Social support is known to have protective effects, especially for caregivers for cancer patients. The aim of this study is to examine the effect of home care practices and perceived social support level of caregivers of cancer patients on the burden of care.

METHODS

A descriptive and cross-sectional study. A total of 222 caregivers were included in the study. In this study, Caregiver and Patient Identification Form, Caregiver's Home Care Practices Questionnaire Form, Zarit Caregiver Burden Scale, Multidimensional Scale of Perceived Social Support, and Karnofsky Performance Scales were used.

RESULTS

Of the caregivers included in the study, it was found that 47.3% were in the 40-61 age group, and 64.4% were women. The total score of caregivers from MSPSS was 61.29 ± 17.27, the total score they received from the Home Care Practices Questionnaire was 28.88 ± 7.72, and the total score they got from the ZBI was 29.11 ± 14.58. It was found that there was a weak and negative correlation between the perceived social support total scores and caregiver burden scores of caregivers (p < .01). In particular, in the regression analysis, a significant correlation was found between the total score of home care practices and personal sub-dimension scores (r: .91, p < .001, tolerance value: .158, VIF: 6.311).

CONCLUSIONS

It has been determined that the increase in home care practices of caregivers of cancer patients and the low level of perceived social support increase the burden of care.

Challenges of Help-Seeking in Iranian Family Caregivers of Patients with Cancer: A Qualitative Study

Background: The nature of cancer is such that it causes several problems for patients and caregivers. As a vital source of support for patients with cancer, family caregivers must seek assistance and make use of available resources to overcome these issues and offer better care for the patient. Objectives: This study aimed at exploring the challenges of seeking help in Iranian family caregivers of patients with cancer from supportive sources. Methods: This qualitative study was conducted from 2019 to 2021 on 15 family caregivers with a wide variety of caring experiences and 13 health professionals (i.e. nurse, physician, social worker, clergyman, and family counselor who were engaged with services for the patient and caregiver) via purposive sampling and semi-structured in-depth interviews in a central cancer care hospital in Isfahan. Graneheim and Lundman's conventional qualitative content analysis approach was used to analyze the data. To assess data trustworthiness, Lincoln and Guba's criteria were used. Data management was performed using MAXQDA (v. 10) software. Results: Four main categories were identified consisted of (1) being strained by social desirability; (2) stigmatizing attitudes toward help-seeking; (3) reactive self-forgetfulness; and (4) resistance to change. Conclusions: The need to develop and implement interventions geared to enhance family caregivers' preferred attitudes and personal skills in order to overcome socio-cultural obstacles to help-seeking behaviors was underlined in this research. Both health care professionals and the community should be prepared to make support services more accessible and usable for family caregivers.

Exploring social capital for family caregivers of patients with chronic organ failure: study protocol for a concept mapping study

INTRODUCTION

Many family caregivers experience significant burdens, especially those who take care of patients with chronic organ failure. Although the social welfare system offers some material assistance, a more sustainable approach to supporting caregivers is warranted. This study aims to explore the social capital (ie, the internal strengths of a community that facilitate different social roles) available for these family caregivers.

METHODS AND ANALYSIS

A participatory design based on Trochim's concept mapping framework will be used in this study. A total of 119 participants, including patients, family caregivers, professionals and other community members, will be recruited from the community. The study will be divided into three phases. In Phase I, qualitative methods will be used to prepare and generate statements. Participants will be asked to share their views on social capital for family caregivers through interviews. In Phase II, quantitative methods will be used to arrange these statements into a concept map, and participants will be asked to complete a questionnaire to prioritise the statements. Statistical methods will be used to create a map based on the responses. In Phase III, the concept map will be used to formulate action plans. The findings will be presented to the public to produce recommendations for social policy.

ETHICS AND DISSEMINATION

This study was approved by The Chinese University of Hong Kong Survey and Behavioural Research Ethics Committee (Reference No.: SBRE-20-714). Informed consent will be obtained from all participants. This study will reveal which forms of social capital can be mobilised to support family caregivers of patients with chronic organ failure. Recommendations on policies to improve the caregiving experience, strengthen social capital and enhance social care will be produced. Findings will be disseminated through academic conferences and journals, as well as local media to create a greater social impact.

TRIAL REGISTRATION NUMBER

ChiCTR2100044171.

Caregivers' satisfaction with cervical cancer care in Ethiopia

BACKGROUND AND PURPOSE

Cervical cancer is the second most common cancer among African women, following breast cancer. Palliative care is among the standards of care in cancer management. While caregivers play key roles in palliative care, their satisfaction with the care influences treatment outcomes and patients' quality of life. This study evaluated caregivers' satisfaction with the care provided to patients with advanced cervical cancer.

METHOD

A cross-sectional evaluation of caregivers' satisfaction with patient care was conducted at a tertiary hospital in Ethiopia. The study tool included the 20-item family satisfaction with advanced cancer care (FAMCARE) and caregiver stress index (CSI). Using binary logistic regression, we identified factors associated with caregivers' satisfaction.

RESULT

A total of 360 caregivers were interviewed. Most of the caregivers were male (58.1%), below the age of 35 years (60.8%), and educated to the high school level or less (64.4%). The average FAMCARE score was 77.7 out of the maximum 100. High satisfaction was observed among subscales "availability of treatment and care" and "psychosocial care," while low satisfaction was observed with "physical patient care" and "provision of information." Caregivers' stress and time dedicated to the caregiving were associated with caregivers' satisfaction.

CONCLUSION

Overall, high satisfaction with advanced care at the tertiary hospital was documented. However, the caregivers also bore high burden of strain. Management of caregivers' strain, prompt treatment of patients' symptoms, and provision of adequate information to the caregivers could further improve caregivers' satisfaction.

Health literacy and eHealth literacy and their association with other caring concepts among carers of people with dementia: A descriptive correlational study

Health literacy (HL) and eHealth literacy (eHL) can facilitate carers of people with dementia (PwD) to search, find, assess and apply information related to dementia-specific issues from different resources. There is a lack of research with regard to HL and eHL among carers of PwD. The aim of this study is to identify the levels of HL and eHL among carers of PwD in Greece and Cyprus and to search for the associations with other caring concepts. This study followed a descriptive correlational design. In total, 174 primary informal carers of PwD, mostly women, over 45 years old and with more than 12 years of education and 67 secondary carers (family, friends or neighbours) participated in the study. Primary informal carers completed a face-to-face survey on the level of HL and eHL, internet use, dementia-specific internet use, care-giving self-efficacy, coping strategies, care-giving perceptions and social support. Primary informal carers reported a high level of eHL and HL. Carers with higher HL were more likely to report higher score of eHL, care-giving self-efficacy and lower score of problematic/dysfunctional coping. Higher score of eHeals-Carer "information seeking" was related with higher use of emotion-focused strategies. From this study, a positive message was received with regard to the role of HL and eHL in the everyday caring life. Non-for-profit organisations and healthcare professionals could integrate in their practice assessment tools and develop tailored training courses for carers enhancing low level of HL and eHL.

Home Care of Tracheostomized Chronically Critically Ill Patients: A Study of Caregivers’ Burden and Comparison with the Burden of Palliative Care Patients in India

Introduction

Chronically critically ill (CCI) patients often have high costs of care and poor outcomes. Disease management programs offering home care may reduce costs but need buy-in from informal caregivers. An understanding of caregiver burden in this population is lacking. We aimed to study the caregiver burden, its change over time, and factors affecting it, in post-ICU tracheostomized patients. We compared the caregiver burden among CCI carers to that of palliative caregivers.

Materials and methods

Informal caregivers of thirty chronically critically ill tracheostomized patients (CGcci) were administered the Caregivers Burden Scale (CBS) tool at discharge, 2 and 4 weeks after discharge. A one-point assessment of burden was made in 30 caregivers of patients enrolled in Pain and Palliative care clinic (CGpc). Linear mixed models for repeated measures were used to analyze score of CGcci over time and compared to the burden in physical, psychologic, economic, time, and social domains between groups.

Results

All 60 caregivers were young (33–35 years), predominantly male, and children of the patients. Both CGcci and CGpc had moderate burden score of 60.5 (14.7) vs 61.5 (13), respectively. Physical burden (11.5 vs 8) was greater in CGcci (p = 0.001) compared to psychologic domain (10 vs 12.5) in CGpc (p = 0.01). Burden score over all domains in CGcci decreased rapidly from 67.5 (8) to 55 (16.5) (p = 0.001) in the first month after discharge.

Conclusion

Burden of care among caregivers of tracheostomized chronically critically ill patients is comparable to those of palliative caregivers and reduces significantly with time.

CTRI

2020/11/029443 (registered on: 27/11/2020)

How to cite this article

Hansda U, Tripathy S, Sahoo AK, Panda I, Shetty AP, Mitra JK, et al. Home Care of Tracheostomized Chronically Critically Ill Patients: A Study of Caregivers’ Burden and Comparison with the Burden of Palliative Care Patients in India. Indian J Crit Care Med 2022;26(5):579–583.

Listening to Caregivers' Voices: The Informal Family Caregiver Burden of Caring for Chronically Ill Bedridden Elderly Patients

The informal family caregiver burden (IFCB) for chronically ill bedridden elderly patients (CIBEPs) is a major issue worldwide. It is a significant challenge due to the ongoing increased palliative care in the family setting; therefore, we explored the IFCB of caring for CIBEPs in Thailand. This article utilized a qualitative method, the total interpretive structural modeling (TISM) approach, with purposive sampling of thirty respondents between September and December 2020. The data were analyzed using cross-impact matrix multiplication applied to classification (MICMAC) to determine the relationship between the driving and dependence power of the enabling factors. The IFCB of the palliative care of CIBEPs was associated with primary care, nursing, extrinsic monitoring and complication prevention. The results showed that the IFCB involves taking responsibility, daily workload, follow-up caring, caring tasks, caregiving strain, financial distress, patient support, external support and caregiving strategy; thus, assistance with taking responsibility, extrinsic monitoring and follow-up care daily tasks may reduce the caregiver burden.

Heart Failure Caregiver Burden and Outcomes: A Systematic Review

Introduction/Objective:

This review aimed to summarize articles describing caregiver burden and the relationship between health outcomes as well as describing interventions focusing on this population.

Methods:

The review used the PRISMA statement and Whittemore and Knafl guidelines. The search engines Scopus, PubMed, Ovid (PsycINFO), and CINAHL were searched for articles published in English.

Results:

This review included 30 studies that met the criteria. Physical, psychological, and social factors were associated with HF caregiver burden. HF caregiver interventions included health education, post-discharge home visits, phone calls, counseling, and support groups that demonstrated some potential to reduce the caregivers’ burden.

Discussion:

Healthcare provider team should screen for caregiver burden and promote healthy behaviors, and strategies to improve quality of life. Further studies should include caregivers as care team members and embed social networking in the interventions for reducing HF caregiver burden. The caregivers’ burden could influence the poor outcomes of care, including physical, psychological, societal, and functional dimensions. Future interventions should develop to alleviate HF caregiver burden.

Assessment of self-efficacy for caregiving in oncology: Italian validation of the caregiver inventory (CGI-I)

Background

The Caregiver Inventory (CGI), a measure of self-efficacy for caregiving that takes into account aspects of caregiving that are neglected by current measures of caregiving, was translated into Italian and validated.

Methods

Ninety-one caregivers from a variety of locations in Italy completed the CGI-Italian (CGI-I) as well as the Hospital Anxiety and Depression Scale (HADS) and the Family Strain Questionnaire - Short Form (FSQ-SF).

Results

A confirmatory factor analysis based on the original CGI factor structure resulted in an adequate fit of the CGI-I using standard fit indices. Thus, the original factor structure was validated in the CGI-I: Managing Medical Information (α = 0.87), Caring for Care Recipient (α = 0.68), Caring for Oneself (α = 0.78), and Managing Difficult Interactions/Emotions (α = 0.55). The CGI-I total score was inversely related to anxiety (HADS, r = − 0.35, p = <.05), and depression (HADS, r = − 0.45, p = <.05). In addition, the CGI-I was inversely related to caregiver stress (FSQ-SF, r = − 0.39, p = <.05). Care of Oneself and Managing Difficult Interactions/Emotions emerged as the strongest and most robust negative relationships with anxiety, depression, and caregiver stress, which replicated, with similar constructs, findings from the original CGI.

Conclusions

The results of this study established the CGI-I as a reliable and valid measure of self-efficacy for caregiving. This study also confirms the importance of self-care and managing difficult communication in the process of successfully navigating the demands of caregiving and in constructing interventions for caregivers who need support.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00849-5.

Perceived Social Support Attenuates the Association between Stress and Health-Related Quality of Life among Adults Experiencing Homelessness

Health-related quality of life (HRQoL) is defined as a multidimensional subjective assessment of one’s physical and mental health. Homelessness is associated with numerous stressors that can reduce HRQoL. Social support is defined as the availability of individuals, or resources provided by individuals, to cope with stress. Interpersonal social support may be important in buffering HRQoL from the negative implications of stress. Here, we examine this association in a marginalized group known for high rates of physical and mental health comorbidities: adults experiencing homelessness. Participants (N = 581; 63.7% men; M_age = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Social support was measured with the 12-item Interpersonal Support Evaluation List (ISEL). HRQoL was measured by the Behavioral Risk Factor Surveillance System (BRFSS) survey using self-rated health, the number of poor mental and poor physical health days over the preceding 30 days, as well as the number of limited activity days as the result of poor mental and/or physical health. Perceived stress was assessed using the 4-item Perceived Stress Scale (PSS). The potential moderation effect of social support was examined by assessing the interaction term of social support and stress in a series of linear regression analyses, controlling for sex, age, months homeless, race, education, health insurance status, serious mental illness diagnosis, and recruitment agency/site. There was a significant interaction effect of social support and stress on the prediction of days of poor physical health, days of poor mental health, and days of limited activity (p in all cases ≤ 0.05). Results add to a growing literature on the potentially protective benefits of social support for HRQoL, extend them to a large sample of adults experiencing homelessness in the South, and demonstrate the significance of this moderating effect of social support over and above the influence of several prominent sociodemographic and diagnostic variables. Future work should determine if interventions designed to enhance social support can buffer HRQoL from the deleterious effects of stress among this vulnerable population.

Reliability, validity and acceptability of the traditional Chinese version of the carer support needs assessment tool in Hong Kong palliative care settings

Background

Among the few existing needs assessment tools for family carers, the 14-item Carer Support Needs Assessment Tool (CSNAT) is the only brief and holistic needs screening tool designed for everyday use in palliative care practices. The aim of this study was to evaluate the reliability, validity, and acceptability of the traditional Chinese version of the CSNAT in palliative care settings in Hong Kong.

Methods

This adopted a cross-sectional and correlation design with repeated measures. The participants were 125 family carers of palliative cancer patients and 10 healthcare providers (HCPs) that were recruited from two local hospitals. The evaluation of psychometric properties included the following: (1) content validity through HCPs including frontline physicians, nurses, social workers, and clinical psychologists; (2) construct validity between the CSNAT items and those of the validated tools that measured caregiver burden, social support, and caregiving self-efficacy; and (3) one-week test-retest reliability in a sub-sample of 81 caregivers. The acceptability of the tool was assessed by the carers using several closed-ended questions.

Results

The content validity index of the CSNAT at the scale level was 0.98. Each item of the CSNAT was significantly and moderately correlated with caregiver burden (Spearman’s r = 0.24 to 0.50) and caregiving self-efficacy (r = − 0.21 to − 0.52), but not for social support. All CSNAT items had fair to moderate test-retest reliability (weighted kappa = 0.21 to 0.48), with the exception of two items “managing your relatives’ symptoms, including giving medicines” and “having time for yourself in the day”.

Regarding the acceptability of the CSNAT, almost all HCPs were willing to use the CSNAT for carer assessment and support. 89.6% of the carers demonstrated a comprehensibility of the CSNAT tool and 92.9% felt comfortable answering the questions. Around 90% of the carers agreed to use the tool for screening, discussing needs, and making referrals.

Conclusion

The traditional Chinese version of the CSNAT is a tool with high validity and acceptability and adequate reliability that measures family carers’ support needs, which should be considered for wide application in local palliative care practices.

Impact of Caregiving Burden on Quality of Life of Caregivers of COPD Patients: The Chain Mediating Role of Social Support and Negative Coping Styles

Purpose

Caregivers of COPD patients experience various caregiving burden, which is related to their quality of life. We aimed to explicitly explore whether social support and negative coping styles play the chain mediating roles in the relationship between the caregiving burden of caregivers of COPD patients and their health-related quality of life.

Methods

We conducted a multicenter cross-sectional survey in four hospitals using a convenience sample. Participants who met the inclusion criteria completed five relevant scales, including a sociodemographic scale. One-way ANOVA and Pearson’s method were used to analyze the data accordingly, and chain mediated effect values were estimated by bootstrap method to determine whether the model holds.

Results

Among the 201 caregivers who participated in this study, the mean age was 55.94 years, most of them were female (61.2%), the mean caregiving burden score was 52.39 ± 14.65, and the quality of life score was 37.97 ± 3.55. Among them, age, gender, education, relationship with the patient, and the number of chronic diseases were the main factors affecting the quality of life score of the caregivers. According to Pearson results, there was a negative correlation between quality of life and caregiving burden, and negative coping styles. The model result showed that caregiving burden could directly and negatively predict quality of life, and also predict quality of life through the chain mediation of social support and negative coping styles.

Conclusion

In China, caregivers of patients with COPD experience severe levels of caregiving burden and low quality of life. The combination of adequate perceived social support and lower negative coping can be effective in alleviating caregiving burden and improving their quality of life. Therefore, healthcare professionals should provide targeted guidance to caregivers with the help of social support and interventions that regulate negative coping styles.

Palliative and End-of-Life Care: More Work is Required

There is currently growing recognition of the complex care needs of patients with life-limiting conditions and their family members, prompting the need to revisit the goals of medicine. This Special Issue reflects a broad research agenda in the field of palliative and end-of-life care. A total of 16 papers of empirical studies and systematic review are included spanning five domains, namely, patient, caregiver, healthcare provider, policy, and methodology. The results generally suggest the merits of palliative care and reveal room for further improvement in palliative care education, manpower, infrastructure, and legal and policy frameworks.