1
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Byrwa DJ, Perez GF, Roach CM, Prentice S, Goetz DM. Airway clearance therapy in the school environment: Retrospective analysis of a cohort of pediatric patients with cystic fibrosis. J Cyst Fibros 2023; 22:811-815. [PMID: 36702656 DOI: 10.1016/j.jcf.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Adherence to airway clearance therapy (ACT) in pediatric cystic fibrosis (CF) patients is reported to be below 50% and inability to sustain daily care is linked to poor health outcomes7,8,9. Through a collaboration between a CF care center and several schools, we hypothesized that ACT completed at school by pediatric CF patients will improve lung function while decreasing pulmonary exacerbations (PEx), days of antibiotics (abx) and hospitalizations. METHODS This was a retrospective case-control study at a single CF care center consisting of 50 CF patients age < 18 at time when data was recorded (2012-2020). The case group used high-frequency chest wall oscillation or positive expiratory pressure devices at school for at least 1 year after self-reported or physician identified inadequate use at home. Lung function and measures of healthcare utilization were collected. RESULTS In the case group (n = 14), paired t-tests showed that after initiation of ACT at school, there were significant reductions in PEx requiring IV or PO abx (P = 0.010), total days of abx (P = 0.032), and visits to the CF care center (P = 0.037). There was no change in these outcomes in the matched control group (n = 36). CONCLUSIONS This is the first known study to highlight an initiative between a CF care center and schools which utilized airway clearance devices at school to ensure pediatric CF patients completed ACT. Through increased adherence, this relationship was associated with improved health outcomes. Use of alternative strategies may help patients with CF sustain adequate airway clearance.
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Affiliation(s)
- David J Byrwa
- John R. Oishei Children's Hospital, Buffalo, NY, United States; University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States; UBMD Pediatrics, Buffalo, NY, United States.
| | - Geovanny F Perez
- John R. Oishei Children's Hospital, Buffalo, NY, United States; University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States; UBMD Pediatrics, Buffalo, NY, United States
| | | | | | - Danielle M Goetz
- John R. Oishei Children's Hospital, Buffalo, NY, United States; University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States; UBMD Pediatrics, Buffalo, NY, United States
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2
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Byrwa DJ, Twist CJ, Skitzki J, Repasky E, Ham PB, Gupta A. A Review of the Use of Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignancy in Pediatric Patients. Cancers (Basel) 2023; 15:2815. [PMID: 37345152 DOI: 10.3390/cancers15102815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC) can directly target microscopic peritoneal disease, has achieved regular consideration in the treatment of several adult cancer types, and is more recently being studied in pediatrics. This review paper provides an overview of the use of this modality in pediatrics in order to identify medication choice, discuss post-operative morbidity and mortality, and evaluate impact on overall survival. Four databases were searched including Scopus, PubMed, Embase, and CINAHL and ultimately 37 papers documenting the use of this modality comprising 264 pediatric patients were included. Malignancies treated include desmoplastic small round cell tumor, rhabdomyosarcoma, angiosarcoma, colorectal carcinoma, and mesothelioma, with several rarer tumor types. Cisplatin was the most commonly used drug for HIPEC at varying concentrations for 30-90 min in duration at temperatures of approximately 41-42 °C. Reported toxicities were generally self-limited and there was no post-operative mortality. The impact on overall survival versus systemic chemotherapy and debulking surgery is uncertain due to lack of clinical trials and very small sample size across tumor subsets and the overall pediatric population. The relationship between degree of tumor burden and extent of surgical debulking needs to be further clarified. Future directions include prospective clinical trials, establishment of patient databases to facilitate standardization of HIPEC in pediatric patients, and additional approaches to optimize HIPEC.
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Affiliation(s)
- David J Byrwa
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA
| | - Clare J Twist
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA
- Division of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Joseph Skitzki
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Elizabeth Repasky
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - P Ben Ham
- Department of Surgery, Division of Pediatric Surgery, John R Oishei Children's Hospital, Buffalo, NY 14203, USA
| | - Ajay Gupta
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA
- Division of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
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3
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Tenzek KE, Grant PC, Depner RM, Levy K, Byrwa DJ. Clinician Communication in Hospice: Constructions of Reality Throughout the End-of-Life Process. Omega (Westport) 2022:302228221116719. [PMID: 35861222 DOI: 10.1177/00302228221116719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study examined qualitative data from hospice clinicians' perspectives on language, surrounding end-of-life (EOL), to understand challenges and opportunities for constructing a trajectory of communication leading towards a good death experience. Findings from two focus groups with nine clinicians' and 12 individual interviews, four of which were follow up interviews after the focus groups, were guided by framework analysis and revealed three themes, constructing language choices, roles and responsibilities, and socio-cultural considerations. We used the Opportunity Model for Presence during the End-of-Life Process (OMP-EOLP) to make sense of the findings and discuss implications for language use throughout the EOL process. We argue additional efforts should be made in recognizing the value of presence checks, re-constructing advance care planning, and utilizing different forms of media as an educational tool and connection mechanism for clinicians with patients and families to achieve a timely engagement of EOL conversations for all healthcare participants.
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Affiliation(s)
- Kelly E Tenzek
- Department of Communication, Baldy Hall University at Buffalo, Buffalo, NY, USA
| | - Pei C Grant
- Phronesis Consulting LLC, Clarence, NY, USA
- Hospice and Palliative Care Buffalo, Cheektowaga, NY, USA
| | - Rachel M Depner
- Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, USA
| | - Kathryn Levy
- Department of Research, Hospice and Palliative Care Buffalo, Cheektowaga, NY, USA
- Department of Planning and Research, Trocaire College, Buffalo, NY, USA
| | - David J Byrwa
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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4
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Depner RM, Grant PC, Byrwa DJ, LaFever SM, Kerr CW, Tenzek KE, LaValley S, Luczkiewicz DL, Wright ST, Levy K, AdvStat MSW. Expanding the Understanding of Content of End-of-Life Dreams and Visions: A Consensual Qualitative Research Analysis. Palliat Med Rep 2020; 1:103-110. [PMID: 34223465 PMCID: PMC8241341 DOI: 10.1089/pmr.2020.0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Research has established End-of-Life Dreams and Visions (ELDVs) as prevalent, meaningful valid experiences that may help patients cope with illness and approaching death. However, no inductive qualitative analysis has explored the phenomenology of ELDVs from the perspective of hospice homecare patients. Objective: The purpose of this study is to evaluate the content of ELDVs by using a rigorous qualitative approach. Design: Five hundred forty-eight ELDVs were collected from weekly interviews of hospice homecare patients and analyzed by using Consensual Qualitative Research Methodology. Settings/Subject: Participants were enrolled in a county-wide hospice homecare program between January 2013-March 2015. Results: The following domains emerged: (1) Interpersonal, (2) Affective Experience and Reflection, (3) Activities, and (4) Setting/Location. Conclusions: This study suggests that ELDV content may include a broader spectrum of experiences that reflect waking life than previously believed. Clinical implications suggest that it may be important for providers to engage with ELDVs, as they are psychologically significant experiences that may be a source of clinical insight.
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Affiliation(s)
- Rachel M. Depner
- Department of Research, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA
- Department of Counseling, School and Educational Psychology, Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Pei C. Grant
- Department of Research, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA
| | - David J. Byrwa
- Department of Research, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA
- Jacobs School of Medicine and Biomedical Sciences, Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Sarah M. LaFever
- Behavioral VA Health Care Line (BVAC), VA Western New York Healthcare System, Buffalo, New York, USA
| | - Christopher W. Kerr
- Department of Research, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA
| | - Kelly E. Tenzek
- Department of Communication, Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Susan LaValley
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Debra L. Luczkiewicz
- Department of Research, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA
| | - Scott T. Wright
- University Counseling Center, University of Rochester, Rochester New York, USA
| | - Kathryn Levy
- Department of Research, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA
- Department of Counseling, School and Educational Psychology, Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
- Jacobs School of Medicine and Biomedical Sciences, Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
- Department of Communication, Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
- Primary Care Research Institute, Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
- Behavioral VA Health Care Line (BVAC), VA Western New York Healthcare System, Buffalo, New York, USA
- University Counseling Center, University of Rochester, Rochester New York, USA
- Department of Planning and Research, Trocaire College, Buffalo, New York, USA
| | - MSW AdvStat
- Department of Research, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA
- Department of Planning and Research, Trocaire College, Buffalo, New York, USA
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5
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Levy K, Grant PC, Kerr CW, Byrwa DJ, Depner RM. Hospice Patient Care Goals and Medical Students' Perceptions: Evidence of a Generation Gap? Am J Hosp Palliat Care 2020; 38:114-122. [PMID: 32588649 DOI: 10.1177/1049909120934737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The ability to perceive care goals of the dying may be an indicator of future quality patient-centered care. Research conducted on end-of-life goals indicates discrepancies between patients and physicians. OBJECTIVE The aim of this study is to compare end-of-life care goals of hospice patients and medical student perceptions of patient care goals. DESIGN Hospice patients and medical students were surveyed on their care goals and perceptions, respectively, using an 11-item survey of goals previously identified in palliative care literature. Medical student empathy was measured using the Interpersonal Reactivity Index. SETTINGS/PARTICIPANTS Eighty hospice patients and 176 medical students (97 first-year and 79 third-year) in a New York State medical school. RESULTS Medical students ranked 7 of the 11 care goals differently than hospice patients: not being a burden to family (p < .001), time with family and friends (p = .002), being at peace with God (p < .001), dying at home (p = .004), feeling that life was meaningful (p < .001), living as long as possible (p < .001), and resolving conflicts (p < .001). Third-year students were less successful than first-year students in perceiving patient care goals of hospice patients. No significant differences in medical student empathy were found based on student year. CONCLUSIONS Medical students, while empathetic, were generally unsuccessful in perceiving end-of-life care goals of hospice patients in the psychosocial and spiritual domains. Differences impeding the ability of medical students to understand these care goals may be generationally based. Increased age awareness and sensitivity may improve future end-of-life care discussions. Overall, there is a need to recognize the greater dimensionality of the dying in order to provide the most complete patient-centered care.
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Affiliation(s)
- Kathryn Levy
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,Department of Planning and Research, Trocaire College, Buffalo, NY, USA
| | - Pei C Grant
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA
| | | | - David J Byrwa
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,School of Medicine, 12292University at Buffalo, the State University of New York, Buffalo, NY, USA
| | - Rachel M Depner
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,Department of Counseling, School and Educational Psychology, 12292University at Buffalo, the State University of New York, Buffalo, NY, USA
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6
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Levy K, Grant PC, Depner RM, Byrwa DJ, Luczkiewicz DL, Kerr CW. End-of-Life Dreams and Visions and Posttraumatic Growth: A Comparison Study. J Palliat Med 2019; 23:319-324. [PMID: 31509062 DOI: 10.1089/jpm.2019.0269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: End-of-life dreams and visions (ELDVs) can provide both meaning and comfort to individuals nearing death. While research has examined the prevalence and content of ELDVs, little is known on how dreaming at end of life may affect psychological processes. Objective: This study aimed to explore differences in posttraumatic growth (PTG) between hospice patients who experience ELDVs and hospice patients who do not experience this phenomenon. Design: This is a multimethod cross-sectional comparison study. Settings/Subjects: 70 hospice patients (35 with ELDV experiences and 35 without ELDV experiences) were recruited after being admitted to a hospice inpatient unit. Measurements: PTG was assessed using a modified version of the Posttraumatic Growth Inventory (PTGI). Demographic information, ELDV occurrence, and a brief description of ELDVs were also collected. Results: Significant differences emerged between groups in terms of personal strength (p = 0.012), spiritual change (p = 0.002), and overall PTG (p = 0.019). Patients with ELDV experiences had higher scores on all subscales as well as overall PTG compared to nondreaming patients. Conclusions: Dreams and visions at the end of life affect PTG of dying individuals in hospice care. Further research should be conducted between groups to examine the effects ELDVs may have on other psychological processes.
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Affiliation(s)
- Kathryn Levy
- Palliative Care Institute, Center for Hospice and Palliative Care, Cheektowaga, New York
| | - Pei C Grant
- Palliative Care Institute, Center for Hospice and Palliative Care, Cheektowaga, New York
| | - Rachel M Depner
- Palliative Care Institute, Center for Hospice and Palliative Care, Cheektowaga, New York.,Department of Counseling, School and Educational Psychology, University at Buffalo, the State University of New York, Buffalo, New York
| | - David J Byrwa
- Palliative Care Institute, Center for Hospice and Palliative Care, Cheektowaga, New York.,School of Medicine, University at Buffalo, the State University of New York, Buffalo, New York
| | - Debra L Luczkiewicz
- Palliative Care Institute, Center for Hospice and Palliative Care, Cheektowaga, New York
| | - Christopher W Kerr
- Palliative Care Institute, Center for Hospice and Palliative Care, Cheektowaga, New York
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7
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Levy K, Grant PC, Depner RM, Tenzek KE, Pailler ME, Beaupin LK, Breier JM, Byrwa DJ. The Photographs of Meaning Program for Pediatric Palliative Caregivers: Feasibility of a Novel Meaning-Making Intervention. Am J Hosp Palliat Care 2019; 36:557-563. [PMID: 30665322 DOI: 10.1177/1049909118824560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Research indicates that informal caregiving can have intense physical and mental impact on the individual. Relative to caregivers of adults, pediatric palliative caregivers appear less in literature despite experiencing greater mental, physical, financial, and social strain. There is limited research on the creation and evaluation of interventions specifically for this population despite clear need. OBJECTIVE This study aims to evaluate the feasibility and engagement of the Photographs of Meaning Program, a modified meaning-making intervention for pediatric palliative caregivers. DESIGN Participants completed a pre-post intervention meaning-in-life measure. Over a 9-week period, participants followed a meaning-making curriculum whereby they created and shared photo narratives via social media. As part of the intervention, a community photo exhibition was held featuring these photo narratives. Exit interviews were also conducted at study close. SETTING/PARTICIPANTS Nine individuals providing informal care to children in a pediatric palliative care program participated in the intervention. All participants were female and are older than 18 years. Settings for research include participant homes and at The Center for Hospice and Palliative Care in Cheektowaga, New York. RESULTS Participants posted 95 photographs and 96 narratives during the intervention, posting on average once each week. Statistical analysis within the small sample indicated an increased presence of meaning in the lives of participants ( P = .022). Exit interviews conveyed satisfaction with the intervention. CONCLUSIONS Findings suggest that the Photographs of Meaning Program is a practical intervention with life-enhancing potential for pediatric palliative. Future research should aim to collect additional evidence of the intervention's effectiveness.
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Affiliation(s)
- Kathryn Levy
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA
| | - Pei C Grant
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA
| | - Rachel M Depner
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA.,2 Department of Counseling, School and Educational Psychology, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Kelly E Tenzek
- 3 Department of Communication, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Megan E Pailler
- 4 Department of Psychosocial Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Jennifer M Breier
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA
| | - David J Byrwa
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA.,6 School of Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
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8
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Depner RM, Grant PC, Byrwa DJ, Breier JM, Lodi-Smith J, Luczkiewicz DL, Kerr CW. "People don't understand what goes on in here": A consensual qualitative research analysis of inmate-caregiver perspectives on prison-based end-of-life care. Palliat Med 2018; 32:969-979. [PMID: 29432706 DOI: 10.1177/0269216318755624] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The age demographic of the incarcerated is quickly shifting from young to old. Correctional facilities are responsible for navigating inmate access to healthcare; currently, there is no standardization for access to end-of-life care. There is growing research support for prison-based end-of-life care programs that incorporate inmate peer caregivers as a way to meet the needs of the elderly and dying who are incarcerated. AIM This project aims to (a) describe a prison-based end-of-life program utilizing inmate peer caregivers, (b) identify inmate-caregiver motivations for participation, and (c) analyze the role of building trust and meaningful relationships within the correctional end-of-life care setting. DESIGN A total of 22 semi-structured interviews were conducted with inmate-caregivers. Data were analyzed using Consensual Qualitative Research methodology. SETTING/PARTICIPANTS All inmate-caregivers currently participating in the end-of-life peer care program at Briarcliff Correctional Facility were given the opportunity to participate. All participants were male, over the age of 18, and also incarcerated at Briarcliff Correctional Facility, a maximum security, state-level correctional facility. RESULTS In total, five over-arching and distinct domains emerged; this manuscript focuses on the following three: (a) program description, (b) motivation, and (c) connections with others. CONCLUSION Findings suggest that inmate-caregivers believe they provide a unique and necessary adaptation to prison-based end-of-life care resulting in multilevel benefits. These additional perceived benefits go beyond a marginalized group gaining access to patient-centered end-of-life care and include potential inmate-caregiver rehabilitation, correctional medical staff feeling supported, and correctional facilities meeting end-of-life care mandates. Additional research is imperative to work toward greater standardization of and access to end-of-life care for the incarcerated.
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Affiliation(s)
- Rachel M Depner
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA.,2 Department of Counseling, School and Educational Psychology, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Pei C Grant
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA
| | - David J Byrwa
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA
| | - Jennifer M Breier
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA
| | | | - Debra L Luczkiewicz
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA
| | - Christopher W Kerr
- 1 Palliative Care Institute, The Center for Hospice & Palliative Care, Cheektowaga, NY, USA
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9
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Mroz EL, Poulin MJ, Grant PC, Depner RM, Breier J, Byrwa DJ, Wright ST. Caregiver Self-Esteem as a Predictor of Patient Relationship Satisfaction: A Longitudinal Study. J Palliat Med 2017; 21:376-379. [PMID: 29068755 DOI: 10.1089/jpm.2017.0231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Longitudinal assessment of patient-caregiver relationships will determine whether caregiver self-esteem determines patient relationship satisfaction at end of life. BACKGROUND Research on close relationships and caregiving supports the idea that informal caregivers' self-esteem may influence their relationships with their terminally ill loved ones. However, this connection has not yet been investigated longitudinally, nor has it been applied specifically to care recipients' relationship satisfaction. METHODS A sample of 24 caregivers and 24 patients in a hospice home care program were recruited. Multiple patient and caregiver interviews were used to conduct a longitudinal study to measure fluctuations in patient health, changes in patient and caregiver relationship satisfaction, and self-esteem over a three-month period. RESULTS An interaction between caregiver self-esteem and patient relationship satisfaction demonstrated the role that self-esteem plays between caregivers and patients enrolled in hospice care. Specifically, for patients with caregivers with low self-esteem, patient relationship satisfaction significantly decreased as the patient's physical health decreased, whereas for patients whose caregivers had high self-esteem, patient relationship satisfaction marginally increased during poorer physical health. DISCUSSION High self-esteem may allow caregivers to overcome feelings of burden and maladaptive anticipatory grief to remain satisfied in their relationship with the patient. Caregiver self-esteem appears to play a role in fostering patient relationship satisfaction at the end of life.
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Affiliation(s)
- Emily L Mroz
- 1 Department of Psychology, University of Florida , Gainesville, Florida
| | - Michael J Poulin
- 2 Department of Psychology, University at Buffalo , Buffalo, New York
| | - Pei C Grant
- 3 Department of Research, Palliative Care Buffalo, The Center for Hospice & Palliative Care , Buffalo, New York
| | - Rachel M Depner
- 3 Department of Research, Palliative Care Buffalo, The Center for Hospice & Palliative Care , Buffalo, New York
| | - Jennifer Breier
- 3 Department of Research, Palliative Care Buffalo, The Center for Hospice & Palliative Care , Buffalo, New York
| | - David J Byrwa
- 3 Department of Research, Palliative Care Buffalo, The Center for Hospice & Palliative Care , Buffalo, New York
| | - Scott T Wright
- 4 Department of Research, Palliative Care Buffalo , Buffalo, New York
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10
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Depner RM, Grant PC, Byrwa DJ, Breier JM, Lodi-Smith J, Kerr CW, Luczkiewicz DL. A consensual qualitative research analysis of the experience of inmate hospice caregivers: Posttraumatic growth while incarcerated. Death Stud 2017; 41:199-210. [PMID: 27874320 DOI: 10.1080/07481187.2016.1237591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A growing number of correctional facilities train inmates to provide end-of-life care for dying inmates. This study explores the phenomenological perspective of inmate-caregivers participating in an inmate-facilitated hospice program (IFHP) with regard to meaning and purpose in life, attitudes on death and dying, and perceived personal impact of participation. Twenty-two inmate-caregivers were interviewed at a maximum-security state correctional facility in the United States. The interviews were transcribed verbatim and analyzed using the Consensual Qualitative Research Methodology. Results suggest that participating in an IFHP may facilitate personal growth and transformation that mirrors the tenets of posttraumatic growth.
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Affiliation(s)
- Rachel M Depner
- a Research Department , Center for Hospice and Palliative Care , Cheektowaga , New York , USA
| | - Pei C Grant
- a Research Department , Center for Hospice and Palliative Care , Cheektowaga , New York , USA
| | - David J Byrwa
- a Research Department , Center for Hospice and Palliative Care , Cheektowaga , New York , USA
| | - Jennifer M Breier
- a Research Department , Center for Hospice and Palliative Care , Cheektowaga , New York , USA
| | | | - Christopher W Kerr
- a Research Department , Center for Hospice and Palliative Care , Cheektowaga , New York , USA
| | - Debra L Luczkiewicz
- a Research Department , Center for Hospice and Palliative Care , Cheektowaga , New York , USA
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