A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers

Experiences of family caregivers in dealing with cases of advanced breast cancer: a qualitative study of the sociocultural context in Punjab, Pakistan

BACKGROUND

Patients with advanced breast cancer require consistent help and support from family caregivers. These caregivers often endure financial burdens and psychological stress, with their experiences significantly influenced by sociocultural factors. This study aims to explore the experiences of family caregivers of advanced breast cancer patients in Punjab province, Pakistan.

METHODS

Data was collected through in-depth interviews with fifteen family caregivers of advanced breast cancer patients in three major cities of Punjab, Pakistan. Caregivers, who had been in close contact with the patient for the last two years, were purposively sampled from five major hospitals. The data was analyzed using thematic analysis.

RESULTS

The study revealed that the experiences of family caregivers are deeply rooted in the sociocultural context. Key themes identified include social responsibility and cultural reciprocity norms; limited awareness and mobility options for caregivers; financial responsibility and strain; impacts of beauty myths and shyness on caregiving attitudes and decisions; the stressful and emotional nature of caregiving; treatment perspectives influenced by social groups; challenges in consulting male physicians and associated stigma; the role of religious beliefs in caregiving; and stress management, with religion often being a coping mechanism. These factors can contribute to delayed treatment decisions for patients.

CONCLUSIONS

Family caregivers are crucial in facilitating timely treatment decisions for advanced breast cancer patients in the Pakistani context. To minimize treatment delays and alleviate caregiver stress, addressing sociocultural barriers in care-seeking is essential. A tailored approach, considering sociocultural and religious factors, is imperative for the management and early diagnosis of breast cancer, necessitating appropriate policymaking and implementation.

Toward a new personalized psycho-social approach for the support of prostate cancer and their caregivers dyads: a pilot study

Introduction

Prostate cancer patients (PCP) often struggle with a significant emotional, physical, and social burden during the care-flow pathway. Noteworthy, PCP should not be considered a standalone patient, but someone who is connected with a relevant social environment and that is usually supported by a beloved one, the caregiver. The involvement of the caregivers through the care pathway might bring significant benefits both on the psychological and the treatment and decision-making side. The present pilot study aimed at preliminarily assessing quantitatively the psychological impact of a prostate cancer diagnosis on the degree of agreement of PCPs and their caregivers on medical decisions, coping resources and psychological distress levels.

Methods

16 PCP and their caregivers were enrolled in the study and fulfilled a battery of standardized questionnaires.

Results

Results showed low concordance in decision making styles and preferences in patients and their caregivers and that the dyads showed similar depression symptoms levels. Relevant features of the psychological needs of the analyzed dyads, such as need for information and support, also emerged.

Conclusion

On the basis of these preliminary results, guidelines for the construction of tailored brief psychological support interventions for PCP dyads are provided.

Psychosocial consequences of head and neck cancer symptom burden after chemoradiation: a mixed-method study

PURPOSE

Patients with head and neck cancer (HNC) experience significant symptom burden from combination chemotherapy and radiation (chemoradiation) that affects acute and long-term health-related quality of life (HRQOL). However, psychosocial impacts of HNC symptom burden are not well understood. This study examined psychosocial consequences of treatment-related symptom burden from the perspectives of survivors of HNC and HNC healthcare providers.

METHODS

This was a cross-sectional, mixed-method study conducted at an NCI-designated comprehensive cancer center. Participants (N = 33) were survivors of HNC who completed a full course of chemoradiation (n = 20) and HNC healthcare providers (n = 13). Participants completed electronic surveys and semi-structured interviews.

RESULTS

Survivors were M = 61 years old (SD = 9) and predominantly male (75%), White (90%), non-Hispanic (100%), and diagnosed with oropharynx cancer (70%). Providers were mostly female (62%), White (46%) or Asian (31%), and non-Hispanic (85%) and included physicians, registered nurses, an advanced practice nurse practitioner, a registered dietician, and a speech-language pathologist. Three qualitative themes emerged: (1) shock, shame, and self-consciousness, (2) diminished relationship satisfaction, and (3) lack of confidence at work. A subset of survivors (20%) reported clinically low social wellbeing, and more than one-third of survivors (35%) reported clinically significant fatigue, depression, anxiety, and cognitive dysfunction.

CONCLUSION

Survivors of HNC and HNC providers described how treatment-related symptom burden impacts psychosocial identity processes related to body image, patient-caregiver relationships, and professional work. Results can inform the development of supportive interventions to assist survivors and caregivers with navigating the psychosocial challenges of HNC treatment and survivorship.

Caregiver experiences of caring for family members with urostomy: a qualitative study

OBJECTIVE

In China, bladder tumors rank first for morbidity and mortality among urological and reproductive system tumors. Total radical cystectomy plus urinary flow conversion is the gold standard for the treatment of muscle-layer invasive bladder cancer. With an increasing number of radical cystectomies each year, the number of patients living with urostomy is growing. After discharge, primary care of urostomy patients is given at home, and high demands are placed on home caregivers due to issues of privacy and the complexity of replacing the urostomy device. This research explored the challenges faced by the family caregivers of urostomy patients.

METHODS

We used descriptive qualitative research methods to conduct interviews with twenty-five family caregivers of patients with urostomy. Survey subjects were from five general hospitals. All interviews were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Three critical challenges were identified-confusion, family crisis, and struggle psychology. Within these three themes, six sub-themes were constructed by coders. They were knowledge and skill deficiency, strong insecurities and uncertainties, role conflict, economic burden, emotional overwhelmed and calm acceptance.

CONCLUSION

Family caregivers play a critical role in patient care, and especially in urostomy care. Caregiving is associated with significant challenges that hinder the family caregiver's ability to effectively care for the patient, further diminishing the caregiver's quality of life. Therefore, healthcare professionals should consider the challenges faced by family caregivers and take measures to obviate them through education, preparation, and support.

Level of caregiving burden and affecting factors in family caregivers of patients with lung cancer: A cross-sectional study

PURPOSE

To determine the caregiving burden level and affecting factors of family members caring for patients with lung cancer (LC).

METHODS

This study used a cross-sectional design and a convenience sampling method. The study was conducted between April 2023 and August 2023 with the LC patients (n = 448) and their caregivers (n = 448) who met the inclusion criteria and were followed up in seven clinics of a specialized hospital for pulmonary diseases in Turkey. Data were collected by using (1) a demographic questionnaire (for patient and caregiver), (2) the Zarit Burden Interview (ZBI), (3) the Beck Depression Inventory (BDI), and (4) the Caregiver Quality of Life Index-Cancer (CQoLC).

RESULTS

The study included 448 caregivers, with a mean age of 45.09 ± 13.48 years, and 71.4% were female. The mean ZBI score of 31.45 ± 16.71 indicated mild to moderate burden. Pearson correlation analysis showed that caregivers' depression levels increased and quality of life decreased significantly as the care burden increased. Multiple regression analysis indicated a significant relationship between the caregiver burden and the patient's age (p < 0.05), caregiver's chronic disease (p < 0.05), type of treatment given to the patient (p < 0.05), patient's metastasis status (p < 0.05) and caregiver's quality of life (p < 0.01).

CONCLUSION

The fact that most of the risk factors identified in this study are non-modifiable highlights the necessity of identifying caregiver burden early by nurses and initiating the appropriate support processes.

Caregiver's quality of life in advanced cancer: validation of the construct in a real-life setting of early palliative care

Introduction

Early palliative care (EPC) improves the quality of life (QoL) of advanced cancer patients and their caregivers. The increasingly widespread use of this care model requires the development of measures supporting its interventions. Although the construct of patient's QoL has been extensively investigated and several QoL measures have been further validated, there is a paucity of data concerning the QoL of the caregiver. In 2018, McDonald and colleagues addressed this issue by interviewing 23 primary caregivers of advanced cancer patients who participated in an EPC randomized clinical trial to understand their perspective on the QoL construct. The Authors identified six major dimensions associated with the construct of caregiver's QoL. The present retrospective study aimed to validate these dimensions on a larger sample and in a real-life EPC setting.

Methods

Previously collected reports from 137 primary caregivers of advanced cancer patients on EPC answering questions about their experience with this care model were qualitatively analyzed through a deductive, thematic approach to identify and confirm the six dimensions constituting the construct of interest based on McDonald's and colleagues' results.

Results

The six dimensions ("living in the patient's world", "burden of illness and caregiving", "assuming the caregiver role", "renegotiating relationships", "confronting mortality", and "maintaining resilience") were consistently found in the reports from primary caregivers in a real-life EPC setting, confirming to be significant themes associated to their QoL.

Conclusion

A definite and recurrent construct of primary caregiver's QoL as described by McDonald and colleagues was also found in a larger sample and in a real-life EPC setting. Thus it may lay the groundwork for the development of a dedicated questionnaire.

A self-management psychoeducational eHealth program to support and empower people with advanced cancer and their family caregivers: Development using the scrum methodology

Background

eHealth programs could be a flexible and scalable resource to support and empower people with advanced cancer and their family caregivers. A face-to-face intervention that has demonstrated effectiveness is the "FOCUS" program, developed and tested in the USA. Recently the FOCUS program was translated and adapted to the European context as part of an international study in six European countries, resulting in the "FOCUS+" program. FOCUS+ served as the basis for development of the web-based iFOCUS program.

Objective

We aim to (1) describe the development process of the iFOCUS program, (2) outline the challenges we encountered and how they were overcome, and (3) present findings regarding the acceptability and usability of iFOCUS.

Methods

We used the four phased agile Scrum methodology to develop iFOCUS and applied set timeframes of rapid program development and evaluation (sprints). Five teams were involved in the development i.e. a core development group, a web development team, an international consortium, audio-visual experts, and potential end-users.

Results

Development followed seven steps, integrated across the four phases of Scrum: (1) concept design, (2) development of mock-ups, (3) Feedback from the international consortium, (4) technical development of iFOCUS, (5) creating versions for the six participating countries, (6) preliminary testing of iFOCUS and (7) implementing the final version in a randomized controlled trial. User testing included 42 participants (twenty patient-family caregiver dyads and two bereaved family caregivers) who reviewed the iFOCUS program. Users found the iFOCUS program to be acceptable and usable. Feedback mainly focused on text size and fonts. Minor changes to the content, tailoring, and program flow were required. During development we encountered program specific and general challenges. Using the Scrum methodology facilitated iterative development to address these issues. For some challenges, such as tailoring, we had to make pragmatic choices due to time and resource limitations.

Conclusions/discussion

The development of a tailored, self-managed psychoeducational eHealth program for people with advanced cancer and their family caregivers is an intense process and requires pragmatic choices. By keeping the emphasis on the target population during development, no specific remarks pertaining to advanced cancer were identified. Some challenges we encountered are common to eHealth development, others were related to program specific requirements. Using the Scrum methodology allows teams to efficiently collaborate during program development and increases the flexibility of the development process. Interpersonal contact between research staff and potential end-users is recommended during and after the development of eHealth programs.

Mindfulness enhances cognitive functioning: a meta-analysis of 111 randomized controlled trials

BACKGROUND

Currently no comprehensive meta-analysis of MBI efficacy on global and unique cognitive subdomains exist.

METHOD

Examined the effects of MBIs on global cognition and 15 cognitive subdomains. Inclusion criteria: meditation naïve participants; randomized controlled trial; outcome included one objective or subjective cognitive functioning measure; primary focus was teaching mindfulness skills. Exclusion criteria: inadequate data; one-session ; control condition contained any MBI component. Robust variance estimation and moderator analyses controlling for presence of treatment fidelity were conducted.

RESULTS

One-hundred-and-eleven RCTs (n = 9,538) met eligibility criteria. MBIs had small-to-moderate significant effects on global cognition, executive attention, working memory accuracy, inhibition accuracy, shifting accuracy, sustained attention, and subjective cognitive functioning (vs. waitlist/no-treatment, g = 0.257-0.643; vs. active controls, g = 0.192-0.394). MBIs did not impact executive functioning (EF) latency indices, verbal fluency, processing speed, episodic memory, and cognitive error. Treatment effects were stronger for those with elevated psychiatric symptoms vs. healthy controls, and medical samples, studies with complete-case (vs. intention-to-treat) analysis, face-to-face (vs. self-guided) delivery, and non-standard (vs. standard MBI).

CONCLUSION

MBIs consistently yielded small-to-moderate yet practically meaningful effect sizes on global cognition and six cognitive subdomains that captured accuracy vs. latency-based indices of EF and sustained accuracy.

A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care

BACKGROUND

Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds.

METHODS

In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques.

RESULTS

Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors).

CONCLUSIONS

Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.

A qualitative exploration of fear of cancer recurrence in caregivers

OBJECTIVE

Fear of cancer recurrence (FCR) is one of the most common unmet needs for cancer patients and caregivers. Yet little is known about the potentially unique nature of caregiver FCR. Our research aimed to address this gap by qualitatively exploring the features and impact of caregiver FCR.

METHODS

Eighteen semi-structured telephone interviews with cancer caregivers were conducted to explore the content and impact of caregiver fears and worries about cancer recurrence or progression. Data analysis used a Framework Approach.

RESULTS

Qualitative analysis identified three themes (1) fear of the patient suffering, (2) the need to protect the patient from a recurrence and/or cancer-related distress, and (3) caregiver's sense of unpreparedness and uncertainty. Underpinning these themes was an overarching sense of personal responsibility for the life of the patient. This overarching theme was identified as a key driver of caregivers' personal and patient-centred fears.

CONCLUSIONS

Our findings confirm the conceptual differences between patient and caregiver FCR. Future research must therefore acknowledge the unique experiences of caregivers and prioritise the development of empirically driven theoretical models, instruments, and interventions for caregiver FCR.

Hope in the era of precision oncology: a qualitative study of informal caregivers' experiences

OBJECTIVES

To explore informal caregivers' perspectives on precision medicine in cancer care.

DESIGN

Semi-structured interviews with the informal caregivers of people living with cancer and receiving targeted/immunotherapies. Interview transcripts were analysed thematically using a framework approach.

SETTING

Recruitment was facilitated by two hospitals and five Australian cancer community groups.

PARTICIPANTS

Informal caregivers (n=28; 16 men, 12 women; aged 18-80) of people living with cancer and receiving targeted/immunotherapies.

RESULTS

Thematic analysis identified three findings, centred largely on the pervasive theme of hope in relation to precision therapies including: (1) precision as a key component of caregivers' hope; (2) hope as a collective practice between patients, caregivers, clinicians and others, which entailed work and obligation for caregivers; and (3) hope as linked to expectations of further scientific progress, even if there may be no personal, immediate benefit.

CONCLUSIONS

Innovation and change in precision oncology are rapidly reconfiguring the parameters of hope for patients and caregivers, creating new and difficult relational moments and experiences in everyday life and in clinical encounters. In the context of a shifting therapeutic landscape, caregivers' experiences illustrate the need to understand hope as collectively produced, as emotional and moral labour, and as entangled in broader cultural expectations of medical advances. Such understandings may help clinicians as they guide patients and caregivers through the complexities of diagnosis, treatment, emerging evidence and possible futures in the precision era. Developing a better understanding of informal caregivers' experiences of caring for patients receiving precision therapies is important for improving support to patients and their caregivers.

Social Support in a Cancer Patient-Informal Caregiver Dyad: A Scoping Review

Social support that includes promoting healthy behaviours throughout the oncology pathway, from diagnosis to treatment to survival, can leverage existing support networks and improve the health of patients and family members in supportive roles. This scoping review aimed to identify and summarise the impact of social support on the patient-informal caregiver relationship during cancer treatment. Inclusion criteria were related to a high focus on dyadic cancer patient-informal caregiver relationships, considering a population of adult cancer patients in active hospitalisation on an oncology ward, and published between 2012 and 2022 to get a portrait of the literature that might influence the current practice. A systematic search using the “Population, Concept, and Context” framework was performed in PubMed, Web of Science, SCOPUS, EBSCO Medline, and CINAHL: 13 articles from the 16,425 pre-qualified articles published between 2012 and 2022. The narrative synthesis of the included studies highlighted that social support, encompassing its different forms within the context of dyads, is frequently associated with an enhanced quality of life, hope, and resilience of both patients and informal caregivers. However, it is important to recognize that the support interventions provided to patients, particularly caregivers, were frequently not thoroughly evaluated or explained, and the sample sizes of the included studies were often limited. Therefore, this review clarified the social and clinical potential of social support for the patient-informal caregiver relationship, paving the way for future robust studies that require to be powered and designed on specific outcomes to allow informing the practice on specific recommendations.

Effect of intimacy and dyadic coping on psychological distress in pancreatic cancer patients and spousal caregivers

Aims

The aim of this study was to investigate the effect of intimacy and dyadic coping on anxiety and depression in patients with pancreatic cancer and their spousal caregivers.

Methods

This study conducted from October 2021 to June 2022, included 277 pancreatic cancer patients and their spousal caregivers. This research used actor-partner interdependence mediation model to explore the relationship of intimacy, dyadic coping, and psychological distress among pancreatic cancer patients and their spousal caregivers.

Results

The results of this study showed that there were two actor effects: the satisfaction of intimate relationship between pancreatic cancer patients and their spouse caregivers had a positive predictive effect on their dyadic coping (β = 1.787, p < 0.001) and (β = 1.587, p < 0.001). The dyadic coping of pancreatic cancer patients and their spouse caregivers had a negative predictive effect on their own anxiety and depression (β = -0.253, p < 0.001) and (β = -0.293, p < 0.001). The results of this study showed that there was a partner effect: intimate relationship satisfaction of pancreatic cancer patients had a positive predictive effect on dyadic coping of their spousal caregivers (β = 0.574, p < 0.05).

Conclusion

This study demonstrates the interdependence of pancreatic cancer patients and their spousal caregivers in coping with the disease. The healthy intimate relationship and effective dyadic coping styles are essential to alleviating disease pressure and lowering the psychological burden on cancer families.

Psychosocial characteristics of patients undergoing cellular immunotherapies and their caregivers across time

Chimeric antigen receptor T-cells and other immunotherapies have markedly changed the paradigm of treatment for patients with relapsed or refractory hematologic malignancies. While notable in efficacy, immunotherapy is characterized by a significant possibility of life-threatening side effects. Consequently, patients are often required to have informal family caregivers present and to stay near the treating center for several weeks after cell infusion. Further, the responsibility of managing a great deal of physical care and emotional support falls to these caregivers. Given the novelty of immunotherapy treatment, there is a need to better understand the psychosocial experience of patients receiving this treatment and their caregivers. This article describes the psychosocial characteristics of patients undergoing cellular immunotherapies and their caregivers across time, including patient/caregiver distress, coping, and caregiver burden and preparedness.

Associations in health-related quality of life between patients and family caregivers 1 year after oesophageal cancer surgery

PURPOSE

Whether patients' health-related quality of life (HRQL) influences the HRQL of their family caregivers remains to be clarified. Therefore, the aim of this study was to investigate the association in HRQL between patients and family caregivers one year after oesophageal cancer surgery.

METHODS

The study was based on a prospective, nationwide, and population-based cohort including patients treated by surgery for oesophageal cancer in Sweden from 2013 to 2021 and their family caregivers. Data were collected one year after surgery, using the summary score of the EORTC QLQ-C30 and the RAND-36 questionnaire. Univariate and multivariate linear regression models providing regression coefficients with confidence intervals (CI) were used to estimate the association between the HRQL among patients and family caregivers. The analyses were adjusted for potential covariates.

RESULTS

In total, 275 patients and paired family caregivers were included in the study. Patients reported a mean HRQL summary score of 81.4, indicating reductions in functions as well as many burdensome symptoms. Among family caregivers, lowest HRQL scores were reported for pain (69.2 ± 26.0) and energy/fatigue (65.1 ± 20.4). A 10-point change in the patients' summary score corresponded to a 7-point change for family caregivers' emotional role function (β = 7.0; 95% CI: 3.6-10.3). For other HRQL dimensions among the family caregivers, no clinically relevant associations with patients HRQL were found.

CONCLUSION

The current study indicates that family caregivers' emotional role function is influenced by patients' overall HRQL one year after surgery. The finding suggests that follow-up interventions should include not only patients but also their family caregivers.

Caregiving and Shared Decision Making in Breast and Prostate Cancer Patients: A Systematic Review

BACKGROUND

A cancer diagnosis can impact patients' and caregivers' lives, posing different challenging situations. In particular, breast cancer and prostate cancer are two types of cancer involving families and especially spouses in challenges linked with the diagnosis and treatment process. Caregivers are usually involved in the treatment decision-making (TDM) process concerning patients' clinical pathway, cancer treatment, and ongoing therapies. To date, no contributions provide an exhaustive overview of the role of caregivers in cancer care and their involvement in the TDM process related to the therapies.

METHODS

We performed a systematic review of caregiver and patients experiences and perceptions of caregiver involvement in cancer TDM. Articles were searched on Public/Publisher MEDLINE (PubMed), Excerpta Medica Database (Embase), Medical Literature Analysis and Retrieval System Online (Medline), and American Psychological Association APA PsycINFO.

RESULTS

17 studies were included, 10 on prostate cancer and 7 on breast cancer. According to the reviewed studies, patients and caregivers experienced the cancer diagnosis with a sense of unity. Most patients preferred to have an active or collaborative role with caregivers in TDM, feeling it was important to consult or share the decision made with their caregivers. Caregivers preferred to collaborate with patients or let patients decide by themselves after considering their opinions. Caregiver involvement could have a positive influence on the patient's medical decisions, even if cancer diagnosis and treatments overwhelmed patients and caregivers.

CONCLUSIONS

These findings highlight the importance of using a perspective that focuses on the relationship between a patient and caregivers when they receive a cancer diagnosis and have to make a treatment decision. Targeting caregiver-patient dyads, rather than individuals, is important since a supported relationship could have a protective effect on psychological distress, quality of life (QOL), and relationship satisfaction. Moreover, dyads may benefit from interventions that focus on the needs of both the patient and caregiver.

Caregiver Burden, Psychological Distress and Quality of Life among Informal Caregivers of Patients with Head and Neck Cancer: A Longitudinal Study

(1) Background: The aim of this study was to investigate caregiver burden among informal caregivers of head and neck cancer patients, in relation to distress and quality of life (QoL), and the relationship between informal caregivers and patients. (2) Methods: Data of 234 dyads from the multicenter prospective cohort study Netherlands Quality of life and Biomedical Cohort studies in cancer was used. Caregiver burden, psychological distress, global QoL, physical and social functioning were measured from baseline until 24 months after treatment. (4) Conclusions: This prospective cohort study shows the high burden of caring for HNC patients, the impact of this burden and the interaction between caregiver and patient. We suggest that healthcare professionals include caregivers in counseling and support.

Palliative care facilitates the preparedness of caregivers for thoracic cancer patients

OBJECTIVE

Palliative care improves outcomes for patients with thoracic cancer; however, limited evidence exists for the benefits of this approach for caregivers. This study aimed to advance understanding of the experiences of palliative care described by bereaved caregivers.

METHODS

Fifteen adult caregivers completed semi-structured interviews following prior participation in a randomised controlled trial of early referral to palliative care versus discretionary referral to palliative care. Interviews explored caregiver experiences of palliative care delivery. Interview transcripts were thematically analysed.

RESULTS

Four related themes about the experiences of palliative care were identified, each of which required sufficient time between palliative care first contact and death: 'relationship building'; 'clear communication and information'; 'access to practical support'; and 'access to psychosocial support'. The core category underpinning these themes was palliative care facilitates caregiver preparedness. Caregivers noted that palliative care played a critical role in preparing them for the future and described a sense of practical and emotional 'relief' associated with the support services made available to them.

CONCLUSION

Our findings emphasise that palliative care can have a positive impact on caregivers' preparedness for providing the care needed by thoracic cancer patients and that this can improve the experiences of both caregivers and patients.

Health-related quality of life measured by EQ-5D-3L for the spouses of breast cancer patients

To explore factors influencing the health-related quality of life of spouses of breast cancer patients and the suitable questionnaires for this purpose. A cross-sectional study was conducted in the Third Affiliated Hospital of Kunming Medical University. The spouses of breast cancer patients were included and evaluated via face-to-face interviews. Self-designed demographic characteristics and disease-related questionnaires, the 12-item health survey questionnaire (SF-12), the three-level European five-dimensional health status scale (EQ-5D-3L), and the Social Support Rate Scale (SSRS) were used. The internal consistency reliability measure Cronbach’s coefficient, criterion-related validity, construct validity, and sensitivity were used to evaluate the applicability of the EQ-5D-3L. Univariate and multivariate analyses were performed to analyze the factors associated with the health-related quality of life of spouses of breast cancer patients. We investigated a total of 100 spouses of breast cancer patients. Cronbach’s α, the internal consistency reliability coefficient, was 0.502. The EQ-5D-3L health utility score was moderately correlated with PCS-12 (r=0.46, p=0.0001) and weakly correlated with MCS-12 (r=0.35, p=0.0001). The EQ-5D-3L health utility score for the spouses of breast cancer patients was 0.870, and the EQ-VAS was 78.3. In multivariate analysis, social support and cognition of the treatment effect were factors that influenced the EQ-5D-3L health utility score. The EQ-5D-3L has good reliability, validity, and sensitivity for measuring the physiological aspects of the health-related quality of life of spouses of BC patients. EQ-5D-3L was considered suitable for this study.

Depression Among the Caregivers of Breast Cancer Patients and its Association with the Quality of Life

Introduction

This study investigated the prevalence of depression among the Jordanian caregivers of patients with breast cancer and its effect on their health-related quality of life (QOL).

Methods

This was a cross-sectional study with a sample that consisted of 122 caregivers recruited from 2 hospitals in Jordan over 5 months. A validated questionnaire was used to assess the prevalence of depression symptoms and the aspects of QOL among the participants using Beck's Depression Inventory-II score and the 36-Item Survey Form (SF-36) score.

Results and Discussion

Depression symptoms were revealed in 27.9% of caregivers. Regarding the QOL, the mental health (MH) subscale was considerably associated with caregivers' age (P=0.007). The marital status of caregivers was significantly associated with pain (Bodily Pain BP) (P=0.015), Beck's Depression Inventory (BDI; P=0.009), and social functioning (SF) (P=0.008). The number of caregivers' siblings was considerably associated with MH (P=0.040) subscale. The monthly income of caregivers was associated with BP (P=0.042). The residency of caregivers was considerably connected with role limitations because of emotional problems (RE) (P=0.027) and role limitations due to physical health (RF) (P=0.013) subscales. There was a significant correlation between the existing family history of depression with RF (P=0.009), RE (P=0.005), SF (P=0.003), and energy/fatigue (Vitality VT) (P=0.001) subscales. Furthermore, the physical activity of caregivers was connected with the RF (P=0.030), general health (GH) (P=0.018), RE (P=0.015), and MH (P=0.003) subscales.

Conclusion

Around a third of the caregivers revealed depression symptoms. The QOL subscales for these caregivers were connected with various health and social factors, such as age, number of siblings, marital status, monthly income, residency, family history of depression, and physical activity. The evaluation of the mental and physical well-being of caregivers should always be considered and managed to help them to cope with their QOL.

A Model of Social Support for a Patient–Informal Caregiver Dyad

Background

Close persons (informal caregivers) are the most important providers of support indicated by cancer patients. Cancer affects couples as a codependent system. The aim of this study was to investigate the factors influencing the multidimensional aspect of social support in a cancer patient–informal caregiver dyad.

Methods

The research project was cross-sectional. The diagnostic survey method and the survey technique were used. The study was conducted using standardised research tools: BSSS, POS, SSCS, TIPI, ET, SPT, and the authors' own tool for sociodemographic assessment.

Results

Patients and caregivers experienced injustice, exclusion, and a sense of loss with a similar intensity. Statistically significant differences between the examined patients and their caregivers were obtained for the support currently received (p < 0.01), emotional support (p < 0.05), and the general level of protective buffering support (p < 0.001). A higher level of information support for caregivers increases the need for support and a sense of support for patients.

Conclusion

The quality of functioning and mental well-being of patients is directly influenced by the way their caregivers experience the situation of caring for them; negative or positive states of caregivers, affecting the condition of patients, may affect the course of treatment and contribute to or delay the improvement of the state of health. The subjective sense of support in patients during treatment depends on the need for help that is shown to their caregivers. The sense of support variable is subjective and sometimes disproportionate to the support received and given. Therefore, both the patient and their loved one should be provided with care during the treatment process. In the treatment process, both patients and their caregivers need more protective buffering support that allows them to overcome difficulties related to stress, anxiety, and insecurity, thus weakening their negative effects rather than functional support: emotional, information, instrumental, or material.

Effect of preoperative psychiatric morbidity on postoperative outcomes of lung cancer surgery: A nationwide cohort study in South Korea

OBJECTIVE

Lung cancer is the leading cause of cancer-related mortality worldwide, and cancer is associated with severe psychological distress. We aimed to investigate whether preoperative psychiatric morbidities affect clinical outcomes of lung cancer surgery in South Korea.

METHODS

Using the National Health Insurance Service database, all adult patients who were diagnosed with lung cancer and underwent lung cancer surgery from January 1, 2011, to December 31, 2018, were included in this retrospective, population-based cohort study. Depression, anxiety disorder, schizophrenia, alcohol abuse, non-alcohol substance abuse, and post-traumatic stress disorder were considered as preoperative psychiatric morbidities.

RESULTS

Overall, 60,031 adult patients who underwent lung cancer surgery were included in the final analysis. Of these, 17,255 (28.7%) patients had preoperative psychiatric morbidity before lung cancer surgery. Multivariable logistic regression modeling revealed patients with preoperative alcohol abuse (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.24, 5.08; P = 0.011) and those with bipolar disorder (OR: 2.91, 95% CI: 1.94, 4.53; P &lt; 0.001) to be associated with increased in-hospital mortality. Moreover, patients with preoperative psychiatric morbidities were associated with longer length of hospitalization (LOS), higher cost of hospitalization, and increased 1-year all-cause mortality.

CONCLUSION

In South Korea, patients with preoperative alcohol abuse and bipolar disorder were associated with increased in-hospital mortality after lung cancer surgery. Moreover, they were associated with increased 1-year all-cause mortality, longer LOS, and higher total costs for lung cancer surgery.

Depressive and Anxiety Disorders of Parents of Children with Cancer

Every year in Poland there are approximately 1200 new cases of malignant tumours in children and adolescents. Leukaemia, CNS tumours, and lymphomas are the most frequently diagnosed cancers. Coping with a child’s illness is challenging, which is why many parents suffer from anxiety, depression disorders, and even PTSD (post-traumatic stress disorder). The aim of this study is to assess the anxiety and depression levels of carers of children with cancer. Method: The study participants were 101 carers of children suffering from cancer. The study was conducted using standardized questionnaires: the Zung ccale, HADS scale, and Karnofsky scale, and three questionnaires designed by the author. Results: According to the results of the Karnofsky scale, carers’ anxiety and depression levels were negatively affected by their children’s poor performance. The younger age of children significantly correlated with the severity of depression in their parents. HADS and Zung scale anxiety levels were observed to have statistically significant effect on the severity of depressive disorders. Conclusions: Receiving a diagnosis of childhood cancer contributes to the incidence of depression and anxiety disorders among carers. Carers’ anxiety and depression levels were strongly associated with their child’s age and their child’s performance.

Caregiver burden and health-related quality of life among family caregivers of oesophageal cancer patients: a prospective nationwide cohort study

BACKGROUND

Oesophageal cancer surgery is extensive with high risk of long-term health-related quality of life (HRQL) reductions. After hospital discharge, the family members often carry great responsibility for the rehabilitation of the patient, which may negatively influence their wellbeing. The purpose was to clarify whether a higher caregiver burden was associated with psychological problems and reduced HRQL for family caregivers of oesophageal cancer survivors.

MATERIAL AND METHODS

This was a nationwide prospective cohort study enrolling family members of all patients who underwent surgical resection for oesophageal cancer in Sweden between 2013 and 2020. The family caregivers reported caregiver burden, symptoms of anxiety, depression, post-traumatic stress, and HRQL 1 year after the patient's surgery. Associations were analysed with multivariable logistic regression and presented as odds ratios (OR) with 95% confidence intervals (CI). Differences between groups were presented as mean score differences (MSD).

RESULTS

Among 319 family caregivers, 101 (32%) reported a high to moderate caregiver burden. Younger family caregivers were more likely to experience a higher caregiver burden. High-moderate caregiver burden was associated with an increased risk of symptoms of anxiety (OR 5.53, 95%CI: 3.18-9.62), depression (OR 8.56, 95%CI: 3.80-19.29), and/or posttraumatic stress (OR 5.39, 95%CI: 3.17-9.17). A high-moderate caregiver burden was also associated with reduced HRQL, especially for social function (MSD 23.0, 95% CI: 18.5 to 27.6) and role emotional (MSD 27.8, 95%CI: 19.9 to 35.7).

CONCLUSIONS

The study indicates that a high caregiver burden is associated with worse health effects for the family caregiver of oesophageal cancer survivors.

Effect of Carnatic raga-Bilahari based music therapy on anxiety, sleep disturbances and somatic symptoms among caregivers of cancer patients

Carnatic raga-Bilahari based intervention is a music therapy technique that enhances relaxation and positivity by reducing anxiety. With extensive empirical evidence pointing out the detrimental challenges faced by the caregivers of cancer patients, the present study intends to find out the effectiveness of a Carnatic raga based music therapy on reducing anxiety, sleep disturbances, somatic symptoms and distress level among this population A single group pre-post research design was was used to conduct the study. General Health Questionnaire (GHQ-28) was used as a screening tool to select participants, and 30 participants were chosen using the purposive sampling. These individuals received instruction in listening to Carnatic music (raga-Bilahari), 5 days a week. The vocal and instrumental recordings were given on alternative days with each session lasting 15–30 min over a month of standard care. From the findings it is observed that there is significant decrease in the anxiety (p < 0.001), sleep disturbances (p < 0.001), somatic symptoms (p < 0.001) and distress level (p < 0.001) after the intervention.The study result thus indicates that Carnatic raga-Bilahari-based music intervention is effective among caregivers of cancer patients to reduce anxiety, sleep disturbances, somatic symptoms presentation, and their distress level.

Psychological Aspects of Care in Cancer Patients in the Last Weeks/Days of Life

Palliative care is comprised of an interdisciplinary team (IDT) approach with members from different disciplines who collaboratively work together to reduce multidimensional components of pain and suffering and improve quality of life for patients coping with a terminal illness. Psychosocial team members are integral to the palliative care IDT and provide expertise in assessment and empirically validated interventions to address psychological distress. The following paper will provide a review of different facets of psychological distress experienced by advanced cancer patients such as psychological disorders, existential distress, spiritual distress, caregiver distress, parental distress, and grief. Finally, an overview of commonly used screening and assessment tools as well as psychological interventions relevant for the palliative care population is presented.

Dyadic Experiences and Psychosocial Management of Couples Facing Advanced Cancer: A Systematic Review of the Literature

Background

Cancer diagnosis and treatment represent a real upheaval both for the patient and for his or her life partner. Adjustment to cancer has been widely studied at the individual level, however, there is little in the literature about the experiences of the couple as an entity. This is especially true with regard to a population facing advanced cancer. This systematic review aimed to make an inventory of 1) the current knowledge relating to the experience of the patient-partner dyad when confronted with advanced cancer, and 2) the psychosocial interventions specifically centered on this dyad.

Method

This review was conducted using the Cochrane methodology. The eligibility criteria for the literature review were: one of the members of the dyad being treated for advanced cancer, dyad composed of the patient and his/her life partner. Databases from PubMed, PsycArticle, PsycInfo, Psychology and Behavioral Sciences Collection and Scopus were investigated. A thematic content analysis on the basis of admitted articles made it possible to respond to each of our research objectives.

Results

Three hundred eighty-nine citations were found. Twenty were admitted to the systematic review of the literature. It highlighted the following experiences of the advanced cancer patient-life partner dyad: uncertainty about the future, disjointed time, intrusion into the couple's intimacy, attachment style and caregiving within the couple, couple's adjustment to cancer symptomatology, the couple's supportive care needs, role changes, nature of communication within the couple, anticipation of the coming death, and the meanings and beliefs around death. This review also describes the range of couple therapies used in the context of advanced cancer: emotionally focused-couple therapy, existential therapy, art therapy, support therapy and couple communication and intimacy promotion. These therapies seem to have individual beneficial effects for both the patient and his or her life partner as well as improving marital functioning.

Conclusions

These results clearly highlight that consideration of the couple and communication within the couple during care are fundamental to dyadic adjustment to advanced cancer. Further studies (qualitative and quantitative) are needed to better understand the couple's experience in order to adapt the management of the couple facing advanced cancer.

Dyadic Interdependence in Non-spousal Caregiving Dyads’ Wellbeing: A Systematic Review

Caregiving dyads (i.e., an informal caregiver and a care recipient) work as an interdependent emotional system, whereby it is assumed that what happens to one member of the dyad essentially happens to the other. For example, both members of the dyad are involved in care giving and care receiving experiences and therefore major life events, such as a serious illness affect the dyad and not only the individual. Consequently, informal caregiving may be considered an example of dyadic interdependence, which is “the process by which interacting people influence one another’s experience.” This systematic review aimed to synthesize studies of dyadic interdependence, specifically in non-spousal caregiving dyads (e.g., adult children—parents, siblings, other relatives, or friends). Electronic databases (PsycINFO, Pubmed, and CINAHL) were systematically searched for dyadic studies reporting on interdependence in the emotional and relational wellbeing of non-spousal caregiving dyads. A total of 239 full-text studies were reviewed, of which 14 quantitative and qualitative studies met the inclusion criteria with a majority of dyads consisting of adult daughters caring for their older mothers. A narrative synthesis suggested mutual influences between non-spousal caregiving dyad members based on: (1) associations between intrapersonal (e.g., psychological functioning) and interpersonal (e.g., relationship processes) variables and emotional and relational wellbeing of the dyad; (2) associations between care context variables (e.g., socio-demographics and care tasks) and emotional and relational wellbeing of the dyad; and (3) patterns of covariation between caregivers’ and care recipients’ wellbeing. Evidence supporting dyadic interdependence among non-spousal caregiving dyads shed light on the ways dyad members influence each other’s wellbeing while providing and receiving care (e.g., via the exchange of support). Future studies investigating mutual influences in dyads, should differentiate subsamples of caregivers based on relationship type, and adopt dyadic and longitudinal designs.

Coding the negative emotions of family members and patients among the high-risk preoperative conversations with the Chinese version of VR-CoDES

Background

Little is known about family members' and patients' expression of negative emotions among high‐risk preoperative conversations.

Objectives

This study aimed to identify the occurrence and patterns of the negative emotions of family members and patients in preoperative conversations, to investigate the conversation themes and to explore the correlation between the negative emotions and the conversation themes.

Methods

A retrospective study was conducted using the Chinese version of Verona Coding Definitions of Emotional Sequences (VR‐CoDES‐C) to code 297 conversations on high‐risk procedures. Inductive content analysis was used to analyse the topics in which negative emotions nested. The χ² Test was used to test the association between the cues and the conversation themes.

Results

The occurrence rate of family members' and patients' negative emotions was very high (85.9%), much higher when compared to most conversations under other medical settings. The negative emotions were mainly expressed by cues (96.4%), and cue‐b (67.4%) was the most frequent category. Cues and concerns were mostly elicited by family members and patients (71.6%). Negative emotions were observed among seven themes, in which ‘Psychological stress relating to illness severity, family's care and financial burden’ (30.3%) ranked the top. Cue‐b, cue‐c and cue‐d had a significant correlation (p < .001) with certain themes.

Conclusions

Family members and patients conveyed significantly more negative emotions in the high‐risk preoperative conversations than in other medical communications. Certain categories of cues were induced by specific emotional conversation contents.

Patient Contribution

Family members and patients contributed to data.

A Systematic Review: The Effect of Cancer on the Divorce Rate

Introduction

Research on the impact of cancer on close relationships brings up conflicting results. This systematic review collects empirical evidence on the research questions whether a cancer diagnosis in general or the type of cancer affects the divorce rate.

Materials and Methods

This systematic review was conducted according to the guidelines of the Cochrane Collaboration and the PRISMA statement. The following electronic databases were searched: Web of Science, Ovid SP MEDLINE, PsycINFO, PsyINDEX, CINAHL, ERIC. Risk of bias assessment was performed with the preliminary risk of bias for exposures tool template (ROBINS-E tool). The grading of methodological quality was assessed with the Newcastle-Ottawa Scale.

Results

Of 13,929 identified records, 15 were included in the qualitative synthesis. In 263,616 cancer patients and 3.4 million healthy individuals, we found that cancer is associated with a slightly decreased divorce rate, except for cervical cancer, which seems to be associated with an increased divorce rate.

Discussion

According to this systematic review, cancer is associated with a tendency to a slightly decreased divorce rate. However, most of the included studies have methodologic weaknesses and an increased risk of bias. Further studies are needed.

Being Present 2.0: Online Mindfulness-Based Program for Metastatic Gastrointestinal Cancer Patients and Caregivers

Purpose

A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers, which may be alleviated by mindfulness interventions. Research on scalable, tailored, online mindfulness training programs is needed. We sought to test the feasibility and acceptability of a remotely delivered 8-week mindfulness-based intervention, Being Present 2.0 (BP2.0).

Methods

We performed a single-arm feasibility study of BP2.0 among patients with any metastatic gastrointestinal cancer receiving chemotherapy, with or without an informal caregiver. Participants were instructed to practice mindfulness using pre-recorded guided meditations 5 times per week using a study-specific website and to attend a weekly live, interactive virtual meeting facilitated by a trained instructor. The web-based platform enabled direct measurement of adherence.

Results

The study enrolled 46 of 74 (62%) patients contacted, together with 23 caregivers (69 participants total), from May to October 2018. Median patient age was 52 (range 20-70 years), 39% were male, 67% non-Hispanic white, 65% had colorectal cancer, and 78% lived outside of San Francisco. The top reasons cited for participation were to reduce stress/anxiety and learn how to meditate. Mean baseline National Comprehensive Cancer Network Distress Thermometer (NCCN DT) scores were 4.7 (patients) and 5.8 (caregivers). The study discontinuation rate was 20% (eight patients and six caregivers). Among the remaining 55 participants, 43 (78%) listened to at least one audio recording and/or attended at least one virtual meeting, although adherence data was incomplete. The retention rate was 71%, with 39 participants completing at least one follow-up assessment. In post-intervention qualitative interviews, 88% of respondents reported a positive experience. Compared to baseline, participants reported significantly reduced post-intervention NCCN DT scores (mean 3.1; P = .012).

Conclusion

The BP2.0 online mindfulness-based program is feasible and acceptable for patients with metastatic gastrointestinal cancer and caregivers. These results will guide plans for a follow-up efficacy study. ClinicalTrials.gov Identifier: NCT03528863.

The shared uncertainty experience of older adults with advanced cancer and their caregivers

OBJECTIVE

One primary source of psychological distress in patients with cancer and their caregivers is uncertainty. However, the uncertainty trajectory and its relationship between older adults with advanced cancer and their caregivers have rarely been examined. This study describes the uncertainty trajectory in patient-caregiver dyads, explores the effect of geriatric assessment (GA) intervention on trajectory, and examines the interdependent relationship of uncertainty.

METHODS

This secondary analysis used longitudinal data from a national cluster-randomized controlled trial examining a GA intervention compared to usual care. Participants completed the modified 9-item Mishel Uncertainty in Illness Scale at enrollment, 4-6 weeks, 3 months, and 6 months. The dyadic growth model and cross-lagged actor-partner interdependence model were used.

RESULTS

A total of 397 dyads (patient age M=76.81 ± SD5.43; caregiver age M=66.69 ± SD12.52) were included. Both had a trend of decreased uncertainty over time (b=-0.16, p<.01). There was a greater decrease in uncertainty among caregivers in the GA group than those in the usual care group (b=-0.46, p=.02). For both patients and caregivers, their past uncertainty was a significant predictor of their own current uncertainty (i.e. actor effect, p<.01). The individual's past uncertainty was a significant predictor of the other dyad member's current uncertainty (i.e. partner effect, p<.05), indicating an interdependent relationship between patient and caregiver uncertainty over time.

CONCLUSIONS

Findings suggest patient and caregiver function as a unit with uncertainty levels affecting each other. Future interventions could build on GA to address uncertainty for older patients with advanced cancer and caregivers.

BACKGROUND

In the United States, there were approximately 1,898,160 new cancer cases reported in 2021; 60% of these cases are associated with individuals 65 years and older.¹ Family members and friends often assume caregiving roles to complement the roles of the healthcare team, especially for older patients.² Diagnosis and treatment of advanced cancer brings substantial stress for both patients and their caregivers.³ Prior studies have shown that older patients experience substantial adverse physical and psychological conditions, such as symptom burden, diminished quality of life, and distress.^4-7 Similarly, caregivers also suffer distress, depression, significant caregiving burden, and impaired quality of life.^2,8-10 Among the myriad psychosocial experiences, uncertainty, defined as the inability to navigate illness-related events and unfamiliar treatment strategies through decision-making or disease understanding, is a common psychological reaction in patients and caregivers.^11,12 Evidence shows that unrelieved uncertainty is associated with decreased quality of life and poor psychological adjustment in older patients with cancer.^13,14 Like other stressors, uncertainty affects both members of the patient-caregiver dyad. Previous studies identified uncertainty as a core overarching theme in the cancer experience and reported high uncertainty levels among caregivers.^12,15,16 This article is protected by copyright. All rights reserved.

Palliative Care Education to Enhance Informal Caregivers’ Skills in Caring for Patients with Cancer: A Scoping Review

Background: Living with cancer causes stress for both patients and caregivers. Empowering family caregivers is critical in palliative care. It is well known that a lack of proper knowledge and training of informal caregivers is a barrier to palliative care provision at home. Objectives: This scoping review aimed to explore palliative care education to enhance informal caregiver skills in caring for cancer patient. Methods: A scoping literature review was conducted with systematic searches in multiple databases – PubMed, Cochrane, PsycINFO and SCOPUS (2000 to 2021). Studies were selected based on programmes content and its impact evaluation.  Findings: The remaining 181 citations were examined at full-text level; 173 studies did not meet inclusion criteria, yielding eight included papers. Four papers focused on palliative care educational programs for family caregivers, and four papers included patients and caregivers. There was a diverse variation in the mode of delivery and duration of educational input. The programs offered an insight into the main elements of working with individuals at a palliative care bundle. Most studies reported that participants improved their knowledge, self-efficacy, and competency and prepared for their roles. Conclusion: The findings indicate the need of family caregivers for more regular and reliable palliative education programs. Randomized controlled trials with rigorous randomization processes, more significant sample numbers and more appropriate control groups focused explicitly on caregiver education may improve the evidence.

Users' evaluation of Japan's cancer information services: process, outcomes, satisfaction and independence

BACKGROUND

Cancer information service (CIS) programmes are becoming increasingly important because patients need to obtain appropriate information and take an active role in their treatment decisions. Programme evaluation is required to determine the level of satisfaction and quality of experiences of users. The purpose of this study is (1) to identify users' evaluation of CIS programmes by both satisfaction and outcomes that reflect the quality of experience and impact of using the CIS, (2) to examine the related factors of these evaluation outcomes and (3) to analyse the differences of those relations between patients and families.

METHOD

The self-reported questionnaire was answered by 447 patients and 216 families of patients who used Cancer Information Support Centres (CISCs) at 16 designated cancer hospitals from January 2016 to April 2016. We developed 12 evaluation items, including satisfaction, experience and the impact of using CISC.

RESULTS

Respondents evaluated the CISC highly, especially in terms of overall satisfaction, followed by the counselling process. Immediate access to CISC was the strongest factor affecting outcomes. Patients who wanted to consult about 'disease or symptoms' or 'had no specific problem' tended to provide high scores for some outcomes, but those who wanted to consult about a 'financial problem' or 'discharge or care at home' provided negative scores. These trends were also observed in families but to a more limited extent.

CONCLUSION

Users' evaluation of CISCs was sufficiently high in terms of overall satisfaction, showing reasonable scores in outcome levels. Immediate access was the strongest factor affecting outcomes and topics of consultation more directly affected evaluation by patients than by families. The distribution of the scores of the measures and related factors was reasonable. The 12-item measurement tool employed in this study seems to be useful for quality monitoring of the CIS.

Dying within dyads: Stress, sense of security and support during palliative home care

Objectives

To examine similarities and dissimilarities in patient and family caregiver dyads in their experience of stress, support, and sense of security.

Methods

144 patients and their family caregivers participated. Patients were admitted to six Swedish specialist palliative home care units and diagnosed with a non-curable disease with an expected short survival. We analysed similarity patterns of answers within dyads (correlations) as well as dissimilarities, expressed as the difference between within-dyad responses. The latter were subjected to a model-building procedure using GLM, with 13 sociodemographic and clinical characteristics as independent variables.

Results

Within dyads, patients and family caregivers scored similar in their perception of support and sense of security with care. There was also dissimilarity within dyad responses in their perception of stress and support that could be attributed to sociodemographic or clinical characteristics. When patients scored higher levels of stress than family caregivers, the family caregiver was more likely to be male. Also family caregiver attachment style (attachment anxiety), patient age and the relationship of the family caregiver to the patient explained dissimilarities within the dyads.

Conclusions

Patients and family caregivers within the dyads often, but not always, had similar scores. We suggest that it is important that the healthcare staff identify situations in which perceptions within the dyads regarding stress and perception of support differ, such that they can recognise patients’ and family caregivers’ unique needs in different situations, to be able to provide adequate support and facilitate dyadic coping.

Psychoeducational Interventions for Caregivers of Persons With Multiple Sclerosis: Protocol for a Randomized Trial

Background

Of the approximately 1 million people living with multiple sclerosis in the United States, more than half receive informal, unpaid care or support from family or friends (caregivers). These caregivers report high levels of stress, anxiety, and negative emotions. Few researchers have conducted psychoeducational interventions for these caregivers.

Objective

This paper presents a protocol for a randomized clinical trial that aims to test the efficacy of two interventions for improving stress, anxiety, depression, and negative emotions for caregivers of persons with multiple sclerosis.

Methods

Participants included any self-identified family or friend caregiver of a person with multiple sclerosis. Data collection began in April 2021 and is expected to continue until November 2021. Participants will be randomized to receive either a website-only or a website-coaching intervention delivered for 6 weeks. Data will be collected at baseline, 6 weeks after baseline (after delivery of intervention), and 6 weeks later.

Results

The protocol was approved by the institutional review board of the Case Western Reserve University on January 21, 2021 (protocol 20201484). As of May 2021, 66 participants were enrolled.

Conclusions

Our findings will have implications for identifying the efficacy of two types of interventions developed for caregivers of persons with multiple sclerosis to reduce negative psychological outcomes associated with caregiving.

Trial Registration

ClinicalTrials.gov NCT04662008; http://clinicaltrials.gov/ct2/show/NCT04662008

International Registered Report Identifier (IRRID)

DERR1-10.2196/30617

Moderators and mediators of emotion regulation therapy for psychologically distressed caregivers of cancer patients: secondary analyses from a randomized controlled trial

BACKGROUND

Being an informal caregiver (IC) of a cancer patient is often associated with psychological distress. We have recently, in a randomized controlled trial (RCT), demonstrated efficacy of Emotion Regulation Therapy for ICs (ERT-C), evidenced as lower levels of psychological distress. Such efficacy demonstration is important, but a crucial step in improving treatments for the IC population is the identification of moderators (i.e., for whom the treatment works) and mediators (i.e., the drivers of the detected effect).

MATERIAL AND METHODS

In a sample of 65 psychologically distressed ICs (combining participants who received immediate and delayed treatment in the RCT); we investigated age, gender, and homework completion as moderators of treatment outcome. Proposed mediators were derived from the ERT model and included mindfulness, emotion regulation dysfunction, decentering, and cognitive reappraisal.

RESULTS AND CONCLUSIONS

The strongest moderation effect was found for homework completion, predicting improvements on psychological distress. Correlational mediation analyses generally supported the ERT model. However, temporal precedence was only established for the association between decentering and worry, where a bidirectional relation was revealed. Homework thus emerged as an important aspect of ERT-C and, albeit a bidirectional relationship, changes in decentering may precede changes in worry. Future trials should ensure the robustness of these results, hone the specificity of process measures, and further investigate the causal timeline of change.

Dyadic effects of family resilience on post-traumatic stress symptoms among breast cancer patients and their primary family caregivers: A cross-sectional study

PURPOSE

The aims of this study were to verify actor and partner effects, by examining the effects of family resilience on post-traumatic stress symptoms (PTSS) among Chinese breast cancer patients and their primary family caregivers.

METHODS

In this cross-sectional study, 104 breast cancer patients (age range 20-75, Mean = 47, Standard Deviation = 10), and their principal caregivers (n = 104), were recruited from a comprehensive cancer center of a public hospital in China. The patients and their caregivers self-reported sociodemographic, family resilience, and PTSS factors. The actor-partner interdependence model were adopted to examine whether the patients and caregivers' perceived family resilience could contribute to their own ("actor effect") and each other's ("partner effect") PTSS.

RESULTS

There were significant correlations between patients' and caregivers' shortened Chinese version of Family Resilience Assessment Scale scores (r = 0.58, p < 0.01) and Post-traumatic Stress Disorder Checklist-Civilian Version scores (r = 0.69, p < 0.01). Caregivers' perceived family resilience was negatively related to their PTSS (actor effect), and the patients' PTSS (partner effect). However, the patients' perceived family resilience was not significantly related to their or the caregivers' PTSS.

CONCLUSIONS

The primary caregivers' perceived family resilience had both actor and partner effects on patient/caregiver PTSS within the first year of breast cancer diagnosis. Family-based interventions should be designed to enhance family resilience to decrease PTSS within families dealing with cancer patients. Supportive care should focus on the primary family caregivers within the first year of breast cancer diagnosis.

Motivations and willingness to provide care from a geographical distance, and the impact of distance care on caregivers' mental and physical health: a mixed-method systematic review protocol

INTRODUCTION

Distance caregivers (DCGs) are a growing population with substantial contribution to informal care. While a reasonable amount is known on the determinants of motives and willingness to provide local informal care, and the local caregiver outcomes, reports for the distance caregiving population are lacking. An evidence synthesis of what motivates and makes DCGs willing to care from a distance and the impact of that care on their mental and physical health would highlight any gaps or consensus in knowledge. This would guide the research needed towards the development of tailored interventions, in order to support DCGs and promote the sustainability of distance care.

METHODS AND ANALYSIS

This protocol adheres to Preferred Items for Reporting of Systematic Reviews and Meta-Analyses Protocols guidelines and the Joanna Briggs Institute (JBI) Methodology for mixed-method reviews. A comprehensive search strategy will be conducted in four electronic databases (CINAHL, MEDLINE, PubMed and PsycINFO). Grey literature will also be assessed to minimise publication bias. Two independent reviewers will assess each study for inclusion and any discrepancies will be resolved with the consultation of a third reviewer. Eligible studies for inclusion will be English language studies exploring the motives and willingness to care for a care recipient with a chronic disease, disability or frailty from a geographical distance; or studies focusing on the mental and physical health outcomes of DCGs. Qualitative and quantitative data will be integrated in a single qualitative synthesis following the JBI convergent integrated approach. Study quality will be assessed using the Mixed Methods Appraisal Tool version 2018.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study as no primary data will be collected. Findings will be disseminated through peer-reviewed publication and presentations at academic conferences and lay summaries for various stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42020156350.

Marital Adjustment in Patients with Cancer: Association with Psychological Distress, Quality of Life, and Sleep Problems

Marital adjustment plays a key role in the physical and psychosocial wellbeing. We conducted a cross-sectional study to evaluate marital adjustment and its association with psychological distress, suicidal ideation, sleep problems, and quality of life in patients with cancer. We collected demographic and clinical information using a structured survey. We assessed marital adjustment, quality of life, psychological distress profile, and sleep problems of participants using validated instruments: the Locke and Wallace Marital Adjustment Test (LWMAT), the Short-Form Health Survey-12, the Beck’s Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Insomnia Severity Index (ISI). Suicidal ideation was assessed with item nine of the BDI. Of the 130 patients (52.3% females, mean age 57.9 ± 12.4 years) enrolled, 20 (15%) were classified as experiencing poor marital adjustment. Moderate to severe depression, anxiety, and insomnia were found in 25.4%, 34.6%, and 24.7% of participants, respectively. Positive suicidal ideation was documented in 13.8% of participants. We found a significant association between poor marital adjustment and depression, anxiety, suicidal ideation, and poor sleep. Our study confirms the relevance of marital adjustment in relation to the psychological wellbeing of patients with cancer. Depression, anxiety, and poor sleep were found to be significantly associated with poor marital adjustment.

The impact of emotion regulation therapy on emotion differentiation in psychologically distressed caregivers of cancer patients

BACKGROUND AND OBJECTIVES

Emotion differentiation is considered adaptive because differentiated emotional experiences are believed to promote access to the information that emotions carry, enabling context-appropriate emotion regulation. In the present study, secondary analyses from a recent randomized controlled trial (O'Toole et al., 2019) were conducted to investigate whether emotion differentiation can improve as a result of psychotherapy and whether improvements in emotion differentiation are associated with reduced distress.

DESIGN AND METHODS

A total of 81 distressed caregivers of cancer patients were randomized to Emotion Regulation Therapy (ERT), an intervention aimed at improving emotion differentiation and facilitating healthy emotion regulation, or a waitlist condition. Emotion differentiation scores could be calculated for 54 caregivers.

RESULTS

Repeated measures ANOVAs revealed that ERT led to significant improvements in negative (η² = 0.21, p = .012), but not positive emotion differentiation (η² = <0.01, p = .973). Correlation analyses showed that improvements in negative emotion differentiation were not associated with changes in distress.

CONCLUSIONS

The results suggest that negative emotion differentiation can improve as a result of psychotherapy. Further research is needed to clarify how improvements in emotion differentiation following therapeutic interventions relate to treatment outcomes such as distress.Trial registration: ClinicalTrials.gov identifier: NCT02322905.

Physical activity, confidence and quality of life among cancer patient-carer dyads

Background

Physical activity (PA) has been positively associated with health-related quality of life (HRQoL) among cancer patients and family caregivers. However, there has been no relevant research for patient-caregiver dyads.

Methods

Path analysis, based on the actor–partner interdependence model (APIM), was used to examine the relationship between physical activity and health-related quality of life and explore the mediating role of emotional distress in 233 dyads.

Results

In both patients and caregivers, physical activity had a direct positive effect on physical quality of life (QoL) but not on mental. There was a significant indirect effect of physical activity on health-related quality of life via emotional distress for both dyad members. Patients’ and caregivers’ confidence in fighting cancer was negatively associated with their own emotional distress. Caregivers’ confidence in fighting cancer was positively associated with their physical activity and also negatively associated with patients’ emotional distress.

Conclusions

Physical activity may be considered as a possible behavioral and rehabilitation strategy for improving health-related quality of life in patient-caregiver dyads and reducing negative symptoms. Future research and intervention may consider cancer patient-family caregiver dyad as a unit of care.

Preparing for partnerships in cancer care: an explorative analysis of the role of family-based caregivers

BACKGROUND

Family-based 'informal' caregivers are critical to enable sustainable cancer care that produces optimal health outcomes but also gives rise to psychological burdens on caregivers. Evidence of psychosocial support for caregivers does not currently address the impacts of their role in providing clinical and health-related care for their loved ones. The present study sought to address this gap including with those from priority populations.

METHODS

Qualitative data was collected using focus group and interview methods. We purposively sampled caregivers identified as having a high burden of responsibility for providing clinical care including those from ethnic minority backgrounds, parental caregivers and those living rurally. Transcripts were subject to thematic analysis utilising a team-based approach.

RESULTS

Family-based caregivers included spouses (11), parents (7), children (1), siblings (1). Ten participants were from ethnic minority backgrounds and five participants were from regional or rural locations. Four resulting inter-related themes were; 1) Dual burden of providing clinical care and managing personal emotional distress; 2) Navigating healthcare partnership dynamics; 3) Developing a caregiving skillset, and 4) Unique supportive needs and barriers to access. These data provide evidence of the unique challenge of providing clinical care as part of family-based caregiving for a loved one with cancer, and the absence of support for caregivers to take up this role.

CONCLUSION

Our findings highlight the substantial contribution of family-based caregivers to the provision of cancer care in contemporary health systems. Inadequate support for caregivers is apparent with regard to their role in providing clinical aspects of care such as medication administration and management. Support programs to prepare caregivers to provide clinical care while building capacity to manage their stressors and emotions through this challenging period may be valuable towards sustainable, person-centred care.

Understanding context: A qualitative analysis of the roles of family caregivers of people living with cancer in Vietnam and the implications for service development in low-income settings

OBJECTIVES

Research on the needs of family caregivers of people living with cancer remains disproportionately focused in high income contexts. This research gap adds to the critical challenge on global equitable delivery of cancer care. This study describes the roles of family caregivers of people living with cancer in Vietnam and possible implications for intervention development.

METHODS

Semi-structured interviews and focus groups with family caregivers (n = 20) and health care providers (n = 22) were conducted in two national oncology hospitals. Findings were verified via workshops with carers (n = 11) and health care professionals (n = 28) in five oncology hospitals representing different regions of Vietnam. Data was analyzed collaboratively by an international team of researchers according to thematic analysis.

RESULTS

Family caregivers in Vietnam provide an integral role in the delivery of inpatient cancer care. In the hospital environment families are responsible for multiple roles including feeding, hydration, changing, washing, moving, wound care and security of personal belongings. Central to this role is primary decision making in terms of treatment and end-of-life care; relaying information, providing nutritional, emotional and financial support. Families are forced to manage severe complications and health care needs with minimal health literacy and limited health care professional input.

CONCLUSIONS

Understanding context and the unique roles of family caregivers of people living with cancer is critical in the development of supportive services. As psycho-oncology develops in low and middle income contexts, it is essential that family caregiver roles are of significant importance.

Burden of caregivers who care for oldest-old parents with disability: A cross-sectional study

OBJECTIVE

To describe the characteristics of oldest-old Chinese with disability and their adult-child caregivers, and the extent to which these characteristics were associated with caregiver burden.

METHODS

The study was based on 168 pairs of disabled oldest-old adults and their adult-child caregivers, derived from the Chinese Longitudinal Healthy Longevity Survey. Descriptive analyses of care recipients' and caregivers' characteristics were conducted respectively, in reference to caregiver burden. Statistically significant characteristics identified in these bivariate analyses were then jointly evaluated in multiple linear regression models with caregiver burden as the outcome.

RESULTS

Care recipients positive emotion status [(β = -0.227 (-0.412, -0.042)], multiple chronic disease [(β = 0.513 (0.081, 0.945)], and caregivers spent more caregiving time [(β = 0.225 (0.061, 0.389)] were main factors associated with caregiver burden.

CONCLUSION

Adult-children caregivers perceived heavier burden if care recipients had low positive emotions, had multiple chronic diseases, and caregivers spent more time caregiving.

Post-traumatic stress symptoms in long-term disease-free cancer survivors and their family caregivers

Background

The experience of cancer is highly stressful and potentially traumatic. We assessed the presence of Post‐Traumatic Stress Symptoms (PTSS) in long‐term cancer survivors and their caregivers, while examining the association between PTSS and clinical, demographic and psychological variables in the long term.

Methods

In this cross‐sectional study 212 survivor‐family caregiver dyads completed measures of post‐traumatic stress symptoms (PTSS) (Impact of Event Scale), depression and anxiety (Hospital Anxiety Depression Scale). Coping strategies, fatigue, cognitive decline, stressful life events and psychopathological history were also assessed among survivors. Data were analyzed using mixed models, accounting both for individual and dyadic effects.

Results

Cancer survivors and their caregivers were assessed after a mean of 6 years after treatment. Twenty per cent of survivors and 35.5% of caregivers had possible posttraumatic stress disorder (PTSD), while 23 patients (11.0%) and 33 caregivers (15.6%) had probable PTSD. Among cancer patients, the severity of post‐traumatic symptoms was associated with an anxious coping style, previous psychopathology and depression (p < 0.001), whereas among caregivers it was associated with depression and having a closer relationship with patients (p < 0.001). Patients’ depression was associated with caregivers’ intrusion symptoms.

Conclusions

High levels of cancer‐related PTSS were still present several years after treatment in both survivors and caregivers. Psychopathology may derive from complex interactions among coping, previous disorders and between‐person dynamics.