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Blake JA, Fields MJ, Bowen P, Ejem D, Clay OJ. Social Support Networks Among Black Caregivers of Persons With Memory Problems. J Gerontol Nurs 2024; 50:22-29. [PMID: 38170460 DOI: 10.3928/00989134-20231211-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Positive social support can predict health outcomes in populations that experience significant burdens, such as minority caregivers. The purpose of the current study was to detail the social network (SN) of 36 Black family caregivers (FCGs) for persons with memory problems (PWMP) and examine differences in SN support depending on FCG gender and relationship to the care recipient. Participants were recruited from the Alzheimer's family program at the University of Alabama at Birmingham and the local community. FCGs were categorized into adult children (ACH), grandchildren and in-law children, and friends and other relatives. FCGs described the amount of adequate support they receive for different types of support from their SN. Female FCGs reported higher levels of support overall, with the largest effect sizes including social (d = 0.63), emotional (d = 0.64), and financial (d = 0.38) support. The largest effect size comparison of caregiver relationship type was in social support, with the ACH group reporting the lowest levels of adequate social support compared to the other two groups (d = 0.48). Findings suggest that different types of Black FCGs face unique challenges depending on their gender and familial relationship to the care recipient. [Journal of Gerontological Nursing, 50(1), 22-29.].
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Tinetti ME, Hladek MD, Ejem D. One Size Fits All-An Underappreciated Health Inequity. JAMA Intern Med 2024; 184:7-8. [PMID: 37983054 DOI: 10.1001/jamainternmed.2023.6035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This Viewpoint discusses why health priorities–tailored care, rather than the one-size-fits-all approach, is beneficial for marginalized individuals.
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Affiliation(s)
- Mary E Tinetti
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | | | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham
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Ejem D, Stockdill M, Edwards R, Dionne-Odom JN, Taylor R, Baehr W, Nabors LB, Bakitas M, Warren P. “It's Not Just the Seizures”: Brain Tumor Caregivers’ Experiences and Educational Needs in Out-of-Hospital Seizure Management. J Palliat Care 2023:8258597231165898. [PMID: 36972511 DOI: 10.1177/08258597231165898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Objective: Family caregivers (FCGs) of persons with primary brain tumors (PBTs) report high levels of distress related to concerns about out-of-hospital seizures. This study aims to explore their experiences and needs with seizure management. Methods: Semi-structured interviews were held with 15 FCGs of persons with PBTs, both those who have and those who have not experienced a seizure, to elicit their concerns about out-of-hospital seizure management and related information needs. A qualitative descriptive study using thematic analysis was conducted based on interview data. Results: Three primary themes were identified relative to FCG experiences and needs related to care of PBTs patients, especially seizure management: (1) FCGs’ experiences with caring for persons with PBTs; (2) FCGs’ educational needs for seizure preparation and resources; and (3) FCGs’ desired type of educational resources and information about seizures. Often FCGs were reported being fearful of seizures and nearly all expressed difficulty knowing when to call emergency services. FCGs equally desired written and online resources, and most preferred graphics or videos detailing seizures. Most FCGs thought that seizure-related training should come after rather than at the time of PBTs diagnosis. FCGs of patients who have not experienced seizures were significantly less prepared to manage seizures than those with a prior seizure. Conclusions: Recognizing and managing out-of-hospital seizures can be a difficult and distressing task for FCGs of patients with PBTs and seizure-related resources are needed. Our results suggest that FCGs of care recipients with PBTs need early supportive interventions to provide self-care strategies and problem-solving skills to manage their roles as caregivers. Interventions should include educational components to assist them in understanding the best mechanisms to maintain a safe environment for their care recipients, and those that deepen knowledge about when to contact EMS.
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Affiliation(s)
- Deborah Ejem
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Macy Stockdill
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rebecca Edwards
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Richard Taylor
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Walter Baehr
- Division of Geriatrics, Gerontology, and Palliative Care, School of Medicine, The University of Alabama, Birmingham, AL, USA
| | - L Burt Nabors
- Department of Neurology, School of Medicine, The University of Alabama, Birmingham, AL, USA
| | - Marie Bakitas
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paula Warren
- Department of Neurology, School of Medicine, The University of Alabama, Birmingham, AL, USA
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Currie ER, Wolfe J, Boss R, Johnston EE, Paine C, Perna SJ, Buckingham S, McKillip KM, Li P, Dionne-Odom JN, Ejem D, Morvant A, Nichols C, Bakitas MA. Patterns of Pediatric Palliative and End-of-Life Care in Neonatal Intensive Care Patients in the Southern U.S. J Pain Symptom Manage 2023; 65:532-540. [PMID: 36801354 DOI: 10.1016/j.jpainsymman.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
CONTEXT Despite high rates of mortality among infants in the Southern U.S., little is known about the timing of pediatric palliative care (PPC), the intensity of end-of-life care, and whether there are differences among sociodemographic characteristics. OBJECTIVES To describe PPC patterns and treatment intensity during the last 48 hours of life among neonatal intensive care unit (NICU) patients in the Southern U.S. who received specialized PPC. METHODS Medical record abstraction of infant decedents who received PPC consultation in two NICUs (in Alabama and Mississippi) from 2009 to 2017 (n = 195) including clinical characteristics, palliative and end-of-life care characteristics, patterns of PPC, and intensive medical treatments in the last 48 hours of life. RESULTS The sample was racially (48.2% Black) and geographically (35.4% rural) diverse. Most infants died after withdrawal of life-sustaining interventions (58%) and had do not attempt resuscitation orders documented (75.9%); very few infants enrolled in hospice (6.2%). Initial PPC consult occurred a median of 13 days after admission and a median of 17 days before death. Infants with a primary diagnosis of genetic or congenital anomaly received earlier PPC consultation (P = 0.02) compared to other diagnoses. In the last 48 hours of life, NICU patients received intensive interventions including mechanical ventilation (81.5%), CPR (27.7%) and surgeries or invasive procedures (25.1%). Black infants were more likely to receive CPR compared to White infants (P = 0.04). CONCLUSION Overall, PPC consultation occurred late in NICU hospitalizations, infants received high-intensity medical interventions in the last 48 hours of life, and there are disparities in intensity of treatment interventions at end of life. Further research is needed to explore if these patterns of care reflect parent preferences and goal concordance.
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Affiliation(s)
- Erin R Currie
- School of Nursing (E.R.C.), University of Alabama at Birmingham, 1701 University Blvd., Birmingham, Alabama, USA.
| | - Joanne Wolfe
- Department of Pediatrics (J.W.), Boston, USA; Harvard Medical School
| | - Renee Boss
- Johns Hopkins University School of Medicine (R.B.)
| | - Emily E Johnston
- The University of Alabama at Birmingham Heersink School of Medicine (E.E.J.), Department of Pediatric Hematology-Oncology
| | | | - Samuel J Perna
- University of Alabama at Birmingham (S,J.P.), Department of Medicine, Gerontology, Geriatrics, and Palliative Care
| | - Susan Buckingham
- University of Alabama at Birmingham (S.B.), Palliative and Hospice Medicine
| | | | - Peng Li
- The University of Alabama at Birmingham School of Nursing (P.L., J.N.O., D.E., M.A.B.)
| | - James N Dionne-Odom
- The University of Alabama at Birmingham School of Nursing (P.L., J.N.O., D.E., M.A.B.)
| | - Deborah Ejem
- The University of Alabama at Birmingham School of Nursing (P.L., J.N.O., D.E., M.A.B.)
| | | | | | - Marie A Bakitas
- The University of Alabama at Birmingham School of Nursing (P.L., J.N.O., D.E., M.A.B.)
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Stockdill ML, Dionne-Odom JN, Wells R, Ejem D, Azuero A, Keebler K, Sockwell E, Tims S, Burgio KL, Engler S, Durant R, Pamboukian SV, Tallaj J, Swetz KM, Kvale E, Tucker R, Bakitas M. African American Recruitment in Early Heart Failure Palliative Care Trials: Outcomes and Comparison With the ENABLE CHF-PC Randomized Trial. J Palliat Care 2023; 38:52-61. [PMID: 33258422 PMCID: PMC8314978 DOI: 10.1177/0825859720975978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Palliative care trial recruitment of African Americans (AAs) is a formidable research challenge. OBJECTIVES Examine AA clinical trial recruitment and enrollment in a palliative care randomized controlled trial (RCT) for heart failure (HF) patients and compare patient baseline characteristics to other HF palliative care RCTs. METHODS This is a descriptive analysis the ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends: Comprehensive Heartcare for Patients and Caregivers) RCT using bivariate statistics to compare racial and patient characteristics and differences through recruitment stages. We then compared the baseline sample characteristics among three palliative HF trials. RESULTS Of 785 patients screened, 566 eligible patients with NYHA classification III-IV were approached; 461 were enrolled and 415 randomized (AA = 226). African Americans were more likely to consent than Caucasians (55%; P FDR = .001), were younger (62.7 + 8; P FDR = .03), had a lower ejection fraction (39.1 + 15.4; PFDR = .03), were more likely to be single (P FDR = .001), and lack an advanced directive (16.4%; P FDR < .001). AAs reported higher goal setting (3.3 + 1.3; P FDR = .007), care coordination (2.8 + 1.3; P FDR = .001) and used more "denial" coping strategies (0.8 + 1; P FDR = .001). Compared to two recent HF RCTs, the ENABLE CHF-PC sample had a higher proportion of AAs and higher baseline KCCQ clinical summary scores. CONCLUSION ENABLE CHF-PC has the highest reported recruitment rate and proportion of AAs in a palliative clinical trial to date. Community-based recruitment partnerships, recruiter training, ongoing communication with recruiters and clinician co-investigators, and recruiter racial concordance likely contributed to successful recruitment of AAs. These important insights provide guidance for design of future HF palliative RCTs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02505425.
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Affiliation(s)
- Macy L. Stockdill
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Sockwell
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sheri Tims
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L. Burgio
- Division of Gerontology, Department of Medicine, Geriatrics, Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raegan Durant
- Division of Preventative Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salpy V. Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose Tallaj
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keith M. Swetz
- Division of Gerontology, Department of Medicine, Geriatrics, Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Kvale
- Department of Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Rodney Tucker
- Department of Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Marie Bakitas
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Dionne‐Odom JN, Ornstein KA, Azuero A, Harrell ER, Gazaway S, Watts KA, Ejem D, Bechthold AC, Lee K, Puga F, Miller‐Sonet E, Williams GR, Kent EE. Bias reported by family caregivers in support received when assisting patients with cancer-related decision-making. Cancer Med 2022; 12:3567-3576. [PMID: 36031864 PMCID: PMC9939189 DOI: 10.1002/cam4.5182] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Family caregivers play an increasing role in cancer treatment decision-making. We examined bias reported by family caregivers in the support they and their patient received from their healthcare team when making these decisions, including associations with distress. METHODS Analysis of 2021 national survey data of family caregivers of patients with cancer (N = 2703). Bias experienced in decision support was assessed with the item: "Have you felt that the support you and the person with cancer have received for making cancer-related decisions by your doctor or healthcare team has been negatively affected by any of the following?" Check-all-that-apply response options included: age, race, language, education, political affiliation, body weight, insurance type or lack of insurance, income, religion, sexual orientation, and gender/sex. Chi-square and regression analyses assessed associations between bias and caregiver distress (GAD-2, PHQ-2). RESULTS Of 2703 caregiver respondents, 47.4% (n = 1281) reported experiencing ≥1 bias(es) when receiving decision support for making cancer-related decisions. Bias was more prevalent among younger caregivers, males, transwomen/men or gender non-conforming caregivers, racial/ethnic minorities, and those providing care over a longer time period. The odds of having high anxiety (GAD-2 scores ≥ 3) were 2.1 times higher for caregivers experiencing one type of bias (adjusted OR, 2.1; 95% CI, 1.6-2.8) and 4.2 times higher for caregivers experiencing ≥2 biases (adjusted OR, 4.2; 95% CI, 3.4-5.3) compared to none. Similar results were found for high depression scores (PHQ-2 scores ≥ 3). CONCLUSIONS Nearly half of caregivers involved in their care recipients' cancer-related decisions report bias in decision support received from the healthcare team. Experiencing bias was strongly associated with high psychological distress.
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Affiliation(s)
- J. Nicholas Dionne‐Odom
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA,Division of GerontologyGeriatrics, and Palliative CareSchool of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA,Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Katherine A. Ornstein
- Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andres Azuero
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Erin R. Harrell
- Department of PsychologyUniversity of AlabamaTuscaloosaAlabamaUSA
| | - Shena Gazaway
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA,Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kristen Allen Watts
- Division of Preventive MedicineSchool of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Deborah Ejem
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Avery C. Bechthold
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kyungmi Lee
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Frank Puga
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | - Grant R. Williams
- Division of Hematology‐OncologySchool of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Erin E. Kent
- Gillings School of Global Public HealthUniversity of North CarolinaChapel HillChapel HillNorth CarolinaUSA
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Gallups SF, Ejem D, Rosenzweig MQ. Power and Privilege: A Critical Analysis of Interpersonal Communication in Health Care as a Guide for Oncology Patient Navigation in Breast Cancer Care. ANS Adv Nurs Sci 2022; 45:227-239. [PMID: 34387214 DOI: 10.1097/ans.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite advances in cancer care, inequalities in race, ethnicity, and social class in breast cancer outcomes still exist. Interpersonal communication is a critical piece to addressing health disparities and it is a core component of the oncology patient navigator role. While widely used, the concept of interpersonal communication is vague, understudied, and requires better clarification to promote equity in health communication. The aim of this article is to investigate the concept of interpersonal communication through a critical lens. Findings from this critical analysis identified a gap in the current literature addressing the intersections of race, gender, and social class.
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Affiliation(s)
- Sarah F Gallups
- Family, Community, and Health Systems, The University of Alabama at Birmingham, School of Nursing (Drs Gallups and Ejem); and Acute and Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania (Dr Rosenzweig)
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Ejem D, Atkins GC, Perkins M, Morhardt DJ, Williams IC, Cothran FA, Epps F, Scott C, Mittelman M, Clay OJ. Stressors and Acceptability of Services Among Black Caregivers of Persons With Memory Problems. J Gerontol Nurs 2022; 48:13-18. [PMID: 35648582 DOI: 10.3928/00989134-20220505-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to identify stressors of Black family caregivers (FCGs) of persons with memory problems (PWMPs), services of interest, and barriers to use of these services. Black FCGs were recruited from the Alzheimer's family program at the University of Alabama at Birmingham and affiliated geriatric clinics, media sources, and word-of-mouth referrals. Of 38 Black FCGs interviewed, 26 (68%) were female, 18 (47%) were employed, and 21 (55%) were adult children. Average age of FCGs was 52.11 years. Mean scores for the AD8 Dementia Screening Scale (mean = 13.95, SD = 2.17) and Clinical Dementia Scale Sum of Boxes (mean = 7.29, SD = 0.87) were higher than clinical cutoffs. The most common stressors for Black FCGs were PWMPs' inability to remember who they were, managing care recipients' financial affairs, and managing PWMPs' comorbid conditions. FCGs were most interested in educational material regarding treatment and diagnosis (55.3%), caring for people with dementia (52.6%), understanding dementia (52.6%), and financial/legal services (52.6%). FCGs stated that transportation difficulties and the need for a relief person were barriers to use of services. Results suggest that Black FCGs may be more likely to participate in interventions that include virtual conferencing modalities. [Journal of Gerontological Nursing, 48(6), 13-18.].
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Dionne-Odom JN, Ornstein KA, Azuero A, Harrell E, Gazaway S, Allen Watts K, Ejem D, Bechthold A, Lee K, Miller-Sonet E, Williams GR, Kent EE. Bias reported by family caregivers of healthcare team support when assisting patients with cancer-related decision-making. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12015 Background: Individuals receiving healthcare services often experience differential treatment based on their personal identity characteristics (e.g., age, race, gender), including in the context of shared decision making with clinicians. Yet, little is reported about the extent of bias experienced by family and friend caregivers from the clinician support they and patients receive when making cancer-related decisions. Methods: Analysis of data from a nationally-representative U.S. online survey conducted by CancerCare (2/2021-7/2021) of family caregivers of patients with cancer (N = 2,703). Bias experienced in decision support was assessed with the item: “Have you felt that the support you and the person with cancer have received for making cancer-related decisions by your doctor or healthcare team has been negatively affected by any of the following?” Check-all-that-apply response options included: age, race, language, education, political affiliation, body weight, insurance type or lack of insurance, income, religion, sexual orientation, and gender/sex. Chi-square was used to compare demographics and bias; regression analyses were used to identify relationships between bias and caregiver’s psychological distress, measured by the GAD-2 and PHQ-2. Results: Out of 2,703 cancer caregiver respondents, 47.4% (n = 1,281) reported experiencing at least one type of bias when receiving healthcare team support for making cancer-related decisions, with body weight (24.7%), age (22.2%), and income level (19.9%) being the most commonly endorsed biases. Experiencing one or more types of bias differed by caregivers’ age (p <.001; younger > older), gender (p <.001; male and transgender/gender nonconforming > females), race (p <.01; African American/Black and Alaskan Native, American Indian, Native Hawaiian, or Pacific Islander > White and Asian), ethnicity (p <.001; higher for Hispanic/Latino), education (p <.01; higher education > less education), and length of time providing care (p <.01; higher for longer time providing care). After covariate adjustment, the odds of having high anxiety (GAD-2 scores≥3) were 3 times higher for caregivers experiencing ≥1 types of bias compared to those experiencing none (adjusted OR, 3.12; 95% CI, 2.6-3.7); similarly, the odds of having high depression symptoms (PHQ-2 scores≥3) were also 3 times higher (adjusted OR, 3.29; 9% CI, 2.8-3.9). Conclusions: Half of caregivers involved in their care recipients’ cancer-related decisions report bias in the decision support received from the healthcare team. Furthermore, experiencing bias was associated with increased odds of experiencing psychological distress. The pervasiveness of bias experienced by families involved in patients’ cancer-related decisions suggests the priority need to critically evaluate and improve clinician decision support practices.
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Affiliation(s)
| | | | | | - Erin Harrell
- University of Alabama, Tuscaloosa, Tuscaloosa, AL
| | | | | | - Deborah Ejem
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Kyungmi Lee
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Erin E. Kent
- University of North Carolina-Chapel Hill, Chapel Hill, NC
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Dionne-Odom JN, Azuero A, Taylor RA, Wells RD, Hendricks BA, Bechthold AC, Reed RD, Harrell ER, Dosse CK, Engler S, McKie P, Ejem D, Bakitas MA, Rosenberg AR. Resilience, preparedness, and distress among family caregivers of patients with advanced cancer. Support Care Cancer 2021; 29:6913-6920. [PMID: 34031751 PMCID: PMC9733586 DOI: 10.1007/s00520-021-06265-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 02/18/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Resilience has been proposed as a primary factor in how many family caregivers of patients with advanced cancer are able to resist psychological strain and perform effectively in the role while bearing a high load of caregiving tasks. To evaluate this hypothesis, we examined whether self-perceived resilience is associated with distress (anxiety and depressive symptoms), caregiver preparedness, and readiness for surrogate decision-making among a racially diverse sample of family caregivers of patients with newly diagnosed advanced cancer. METHODS Secondary analysis of baseline data from two small-scale, pilot clinical trials that both recruited family caregivers of patients with newly diagnosed advanced cancer. Using multivariable linear regression, we analyzed relationships of resilience as a predictor of mood, caregiving preparedness, and readiness for surrogate decision-making, controlling for sociodemographics. RESULTS Caregiver participants (N = 112) were mean 56 years of age and mostly female (76%), the patient's spouse/partner (52%), and White (56%) or African-American/Black (43%). After controlling for demographics, standardized results indicated that higher resilience was relevantly associated with higher caregiver preparedness (beta = .46, p < .001), higher readiness for surrogate decision-making (beta = .20, p < .05) and lower anxiety (beta = - .19, p < .05), and depressive symptoms (beta = - .20, p < .05). CONCLUSIONS These results suggest that resilience may be critical to caregivers' abilities to manage stress, be effective sources of support to patients, and feel ready to make future medical decisions on behalf of patients. Future work should explore and clinicians should consider whether resilience can be enhanced in cancer caregivers to optimize their well-being and ability to perform in the caregiving and surrogate decision-making roles.
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Affiliation(s)
| | - Andres Azuero
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Richard A. Taylor
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Rachel D. Wells
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | | | - Avery C. Bechthold
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Erin R. Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Chinara K. Dosse
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Sally Engler
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Peggy McKie
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Marie A. Bakitas
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Abby R. Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA,Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, WA, USA
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11
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Gazaway SB, Barnett MD, Bowman EH, Ejem D, Harrell ER, Brown CJ, Bakitas M. Health Professionals Palliative Care Education for Older Adults: Overcoming Ageism, Racism, and Gender Bias. Curr Geriatr Rep 2021; 10:148-156. [PMID: 34745842 PMCID: PMC8556773 DOI: 10.1007/s13670-021-00365-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/03/2022]
Abstract
Purpose of review Most aging Americans lack access to specialist palliative care aimed at those experiencing serious illness and/or high symptom burden at end of life. The curricula used by training programs for all healthcare professions should focus on helping learners develop the primary palliative care skills and competencies necessary to provide compassionate bias-free care for adults with serious illness. We believe there is much opportunity to improve this landscape via the incorporation of palliative care competencies throughout generalist healthcare professional programs. Recent findings Several recent publications highlight multiple issues with recruitment and retention of diverse students and faculty into healthcare professional training programs. There are also concerns that the curricula are reinforcing age, race, and gender biases. Due to these biases, healthcare professionals graduate from their training programs with socialized stereotypes unquestioned when caring for older adult minority patients and caregivers. Summary Important lessons must be incorporated to assure that bias against age, race, and gender are discovered and openly addressed in healthcare professional’s education programs. This review highlights these three types of bias and their interrelationships with the aim of revealing hidden truths in the education of healthcare professionals. Ultimately, we offer targeted recommendations of focus for programs to address implicit bias within their curricula.
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Affiliation(s)
- Shena B. Gazaway
- School of Nursing Center for Palliative and Supportive Care, University of Alabama, 1720 2nd Avenue South, AL 35294-1210 Birmingham, USA
| | - Michael D. Barnett
- Associate Professor of Medicine & Pediatrics, Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, USA
| | - Ella H. Bowman
- Professor of Medicine, Section Chief of Geriatric Medicine, University of Alabama at Birmingham, Alabama VA Health Care System, Birmingham, USA
| | - Deborah Ejem
- Assistant Professor School of Nursing, University of Alabama Birmingham, Birmingham, USA
| | - Erin R. Harrell
- Assistant Professor Department of Psychology, University of Alabama, Tuscaloosa, USA
| | - Cynthia J. Brown
- Professor and Chair Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans , USA
| | - Marie Bakitas
- Professor and Associate Dean for Research and Scholarship School of Nursing Center for Palliative and Supportive, University of Alabama, Birmingham, USA
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Wells R, Dionne-Odom JN, Azuero A, Buck H, Ejem D, Burgio KL, Stockdill ML, Tucker R, Pamboukian SV, Tallaj J, Engler S, Keebler K, Tims S, Durant R, Swetz KM, Bakitas M. Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients. J Pain Symptom Manage 2021; 62:471-481. [PMID: 33556493 PMCID: PMC8339177 DOI: 10.1016/j.jpainsymman.2021.01.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Research priority guidelines highlight the need for examining the "dose" components of palliative care (PC) interventions, such as intervention adherence and completion rates, that contribute to optimal outcomes. OBJECTIVES Examine the "dose" effect of PC intervention completion vs. noncompletion on quality of life (QoL) and healthcare use in patients with advanced heart failure (HF) over 32 weeks. METHODS Secondary analysis of the ENABLE CHF-PC intervention trial for patients with New York Heart Association (NYHA) Class III/IV HF. "Completers" defined as completing a single, in-person outpatient palliative care consultation (OPCC) plus 6 weekly, PC nurse coach-led telehealth sessions. "Non-completers" were defined as either not attending the OPCC or completing <6 telehealth sessions. Outcome variables were QoL and healthcare resource use (hospital days; emergency department visits). Mixed models were used to model dose effects for "completers" vs "noncompleters" over 32 weeks. RESULTS Of 208 intervention group participants, 81 (38.9%) were classified as "completers" with a mean age of 64.6 years; 72.8% were urban-dwelling; 92.5% had NYHA Class III HF. 'Completers' vs. "non-completers"" groups were well-balanced at baseline; however "noncompleters" did report higher anxiety (6.0 vs 7.0, P < 0.05, d = 0.28). Moderate, clinically significant, improved QoL differences were found at 16 weeks in "completers" vs. "non-completers" (between-group difference: -9.71 (3.18), d = 0.47, P = 0.002) but not healthcare use. CONCLUSION Higher intervention completion rates of an early PC intervention was associated with QoL improvements in patients with advanced HF. Future work should focus on identifying the most efficacious "dose" of intervention components and increasing adherence to them. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02505425.
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Affiliation(s)
- Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - James Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harleah Buck
- Csomay Center for Gerontological Excellence, College of Nursing, University of Iowa Iowa City, IA, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L Burgio
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
| | - Macy L Stockdill
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodney Tucker
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sheri Tims
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raegan Durant
- Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keith M Swetz
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
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13
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Ejem D, Steinhauser K, Dionne-Odom JN, Wells R, Durant RW, Clay OJ, Bakitas M. Exploring Culturally Responsive Religious and Spirituality Health Care Communications among African Americans with Advanced Heart Failure, Their Family Caregivers, and Clinicians. J Palliat Med 2021; 24:1798-1806. [PMID: 34182804 DOI: 10.1089/jpm.2021.0044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Religion and spirituality (R/S) impact how African Americans (AAs) cope with serious illness, yet are infrequently addressed in patient-clinician communication. Objectives: To explore AAs with advanced heart failure and their family caregivers' (FCGs) preferences about R/S in patient-clinician communication. Methods: An embedded qualitative interview within a parent randomized trial about the role of R/S in the illness experience and in clinician interactions with patients and FCGs in a Southern U.S. state. Transcribed interviews were analyzed using constant comparative analysis to identify emergent themes. Results: AA participants (n = 15) were a mean age of 62 years, were female (40%), and had >high school diploma/GED (87%). AA FCGs (n = 14) were a mean age of 58; were female (93%); had >high school diploma/General Education Development (GED) (93%); and were unemployed (86%). Most (63%) were patients' spouses/partners. All patients and FCGs were Protestant. Participants reported the critical role of R/S in living with illness; however, patients' and FCGs' perspectives related to inclusion of R/S in health care communications differed. Patients' perspectives were as follows: (1) R/S is not discussed in clinical encounters and (2) R/S should be discussed only if patient initiated. FCGs' perspectives about ideal inclusion of R/S represented three main diverging themes: (1) clinicians' R/S communication is not a priority, (2) clinicians should openly acknowledge patients' R/S beliefs, and (3) clinicians should engage in R/S conversations with patients. Conclusion: Key thematic differences about the role of R/S in illness and preferences for incorporating R/S in health care communications reveal important considerations about the need to assess and individualize this aspect of palliative care research and practice.
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Affiliation(s)
- Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karen Steinhauser
- Departments of Population Health Sciences, and Medicine, Center for the Study of Aging and Human Development, Duke University; Durham VA Adapt Center of Innovation, Durham, North Carolina, USA
| | | | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Raegan W Durant
- School of Medicine-Division of Preventive Medicine, and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Warren P, Ejem D, Taylor R, Edwards R, Dionne-Odom J, Nabors L, Bakitas M. QOLP-41. ASSESSING CAREGIVERS’ OF PATIENTS WITH PRIMARY BRAIN TUMORS EXPERIENCES WITH AND NEEDS RELATED TO SEIZURE MANAGEMENT. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Family caregivers of persons with primary brain tumors report high levels of distress. Information is limited, however, regarding family caregivers’ experiences and needs concerning the risk and management of seizures in this population. In this qualitative descriptive study, we conducted one-on-one interviews to describe the experiences of family caregivers’ of persons with primary brain tumors who have had and who have not yet had a seizure. We sought information on how they coped with this issue and what information they needed regarding management of out-of-the-hospital seizures. We conducted 15 interviews using study-specific interview protocols; 10 caregivers with seizure experience and 5 caregivers without seizure experience. Caregivers were, on average, 52 years old, predominately white (93.3%), college graduates (66.7%), and were employed full-time (53.3%). The relationship between caregiver and care recipient was spouse (46.7%), other family member (46.7%), and friend (6.6%). Most caregivers provided care everyday (46.7%) and for more than 8 hours per day (33.3%). Themes emerged around three major domains: 1) caregiver challenges regarding seizures, 2) desired resources/information about seizures, and 3) timing of delivery of these resources. Caregivers often reported being fearful of seizures and the majority (93%) expressed difficulty with knowing when to call EMS. In terms of desired resources, opinions were split between preferring written materials versus online resources with most participants (87%) stating that videos or graphics detailing seizures would be helpful. In terms of delivery timing, most (66.7%) thought that training should come after diagnosis versus at the time of diagnosis citing reasons such as too much other information to absorb and overall inability to focus. Future studies will use this information to develop and pilot a seizure-focused supportive caregiver intervention that is tailored and caregiver-directed and that can be incorporated into standard neuro-oncology clinical practice.
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Affiliation(s)
| | - Deborah Ejem
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard Taylor
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Louis Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie Bakitas
- University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Turkman YE, Williams CP, Jackson BE, Dionne-Odom JN, Taylor R, Ejem D, Kvale E, Pisu M, Bakitas M, Rocque GB. Disparities in Hospice Utilization for Older Cancer Patients Living in the Deep South. J Pain Symptom Manage 2019; 58:86-91. [PMID: 30981781 PMCID: PMC6592766 DOI: 10.1016/j.jpainsymman.2019.04.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Hospice utilization is an end-of-life quality indicator. The Deep South has known disparities in palliative care that may affect hospice utilization. OBJECTIVES The objective of this study was to evaluate the association among Deep South patient and hospital characteristics and hospice utilization. METHODS This retrospective cohort study evaluated patient and hospital characteristics associated with hospice among Medicare cancer decedents aged ≥65 years in 12 southeastern cancer centers between 2012 and 2015. We examined patient-level characteristics (age, race, gender, cancer type, and received patient navigation) and hospital-level characteristics (board-certified palliative physician, inpatient palliative care beds, and hospice ownership). Outcomes included hospice (within 90 vs. three days of death). Relative risks (RRs) and 95% CIs evaluated the association between patient- and hospital-level characteristics and hospice outcomes using generalized log-linear models with Poisson distribution and robust variance estimates. RESULTS Of 12,725 cancer decedents, 4142 (33%) did not utilize hospice. "No hospice" was associated with nonwhite (RR 1.24, 95% CI 1.17-1.32) and nonnavigated patients (RR 1.17, 95% CI 1.10-1.25), and those at a hospital with inpatient palliative care beds (RR 1.15, 95% CI 1.10-1.21). "Late hospice" (20%; n = 1458) was associated with being male (RR 1.31, 95% CI 1.19-1.44) and seen at a hospital without inpatient palliative care beds (RR 0.82, 95% CI 0.75-0.90). CONCLUSIONS Hospice utilization differed by patient and hospital characteristics. Patients who were nonwhite, and nonnavigated, and hospitals with inpatient palliative care beds, were associated with no hospice. Research should focus on ways to improve hospice utilization in Deep South older cancer patients.
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Affiliation(s)
| | - Courtney P Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - James Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Elizabeth Kvale
- Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Maria Pisu
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gabrielle B Rocque
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Comprehensive Cancer Center, UAB Medicine, Birmingham, Alabama, USA
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16
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Dionne-Odom JN, Ejem D, Wells R, Barnato AE, Taylor RA, Rocque GB, Turkman YE, Kenny M, Ivankova NV, Bakitas MA, Martin MY. How family caregivers of persons with advanced cancer assist with upstream healthcare decision-making: A qualitative study. PLoS One 2019; 14:e0212967. [PMID: 30865681 PMCID: PMC6415885 DOI: 10.1371/journal.pone.0212967] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/12/2019] [Indexed: 12/27/2022] Open
Abstract
Aims Numerous healthcare decisions are faced by persons with advanced cancer from diagnosis to end-of-life. The family caregiver role in these decisions has focused on being a surrogate decision-maker, however, little is known about the caregiver’s role in supporting upstream patient decision-making. We aimed to describe the roles of family caregivers in assisting community-dwelling advanced cancer patients with healthcare decision-making across settings and contexts. Methods Qualitative study using one-on-one, semi-structured interviews with community-dwelling persons with metastatic cancer (n = 18) and their family caregivers (n = 20) recruited from outpatient oncology clinics of a large tertiary care academic medical center, between October 2016 and October 2017. Transcribed interviews were analyzed using a thematic analysis approach. Findings Caregivers averaged 56 years and were mostly female (95%), white (85%), and the patient’s partner/spouse (70%). Patients averaged 58 years and were mostly male (67%) in self-reported “fair” or “poor” health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients’ upstream healthcare decision-making were: 1) seeking information about the cancer, its trajectory, and treatments options; 2) ensuring family and healthcare clinicians have a common understanding of the patient’s treatment plan and condition; 3) facilitating discussions with patients about their values and the framing of their illness; 5) posing “what if” scenarios about current and potential future health states and treatments; 6) addressing collateral decisions (e.g., work arrangements) resulting from medical treatment choices; 6) originating healthcare-related decision points, including decisions about seeking emergency care; and 7) making healthcare decisions for patients who preferred to delegate healthcare decisions to their family caregivers. Conclusions These findings highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early decision support interventions for family caregivers.
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Affiliation(s)
- J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amber E. Barnato
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Richard A. Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Gabrielle B. Rocque
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Yasemin E. Turkman
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Matthew Kenny
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Nataliya V. Ivankova
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michelle Y. Martin
- Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
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Rice M, Soistmann HC, Ejem D, Johnson AH, Turner-Henson A, Davis SL, Gray L. Recruitment of hard to contact, hard to engage child populations in clinics and schools. Appl Nurs Res 2019; 46:72-77. [PMID: 30773242 DOI: 10.1016/j.apnr.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/06/2018] [Revised: 11/22/2018] [Accepted: 12/08/2018] [Indexed: 01/23/2023]
Abstract
Recruiting children with chronic disease or subgroups of children (low income, obese, specific ages, types of cancer) from clinics and schools for research studies may be particularly difficult. While some have deemed such groups as hard to reach, these groups may be more accurately described as either hard to contact or hard to engage. This is not because children are unknown to the school or clinic but because the researcher's ability to communicate directly with targeted children prior to enrollment is limited. The purpose of this paper is to describe barriers and possible strategies for recruiting hard to contact or hard to engage subgroups of children. Barriers identified in recruiting these children were: naïve to research, communication style and technology, parent/guardian burden, parental conditions and concerns, child stressors and distractions, and research setting. Possible strategies include: pre-consent education, information sheets about study, identifying preferred method of communication, meaningful and appropriate incentives, coordinating recruitment visit with regularly scheduled clinic appointments or school schedule, demonstrating research equipment, informing staff about research study, negotiating creatively for space for research, and emphasizing confidentiality of data. Consideration of barriers to recruitment and utilization of strategies to counteract these barriers is critical to the success of a study involving subgroups of children.
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Affiliation(s)
- Marti Rice
- University of Alabama at Birmingham School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Heather C Soistmann
- University of Alabama at Birmingham School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Deborah Ejem
- University of Alabama at Birmingham School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | | | - Anne Turner-Henson
- University of Alabama at Birmingham School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Sara L Davis
- University of South Alabama, Mobile, AL, United States of America
| | - Laura Gray
- Belmont University, Nashville, TN, United States of America
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Dionne-Odom JN, Ejem D, Wells R, Barnato A, Taylor R, Rocque GB, Turkman YE, Ramsey T, Kenny M, Ivankova N, Bakitas M, Martin MY. How family caregivers assist with upstream health care decision making by community-dwelling persons with advanced cancer: A qualitative study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.34_suppl.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13 Background: In the palliative care context, the family caregiver role in patients’ healthcare decision-making has focused on being a surrogate decision-maker at end of life. Less is known about family caregiver’s role in supporting upstream patient decision-making in advanced cancer. Methods: Qualitative descriptive study consisting of one-on-one, semi-structured interviews with persons with metastatic cancer and their family caregivers. We elicited family members’ perspectives on how they assist their relatives with any current and prospective healthcare decisions. Transcribed interviews were analyzed using a thematic analysis approach. Co-investigators reviewed and refined themes. Results: Caregivers (n = 20) averaged 56 years of age and were mostly female (95%), White (85%), and the patient’s partner/spouse (70%). Patients (n = 18) averaged 58 years of age and were mostly male (67%) in “fair” or “poor” health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients’ decision-making were: 1) seeking information about the cancer, its trajectory, and different treatments options; 2) identifying treatment and disease decision points, including decisions about seeking emergent care; 3) ensuring family members have a common understanding of the patient’s plan of care; 4) initiating and facilitating conversations with patients about coping, values, beliefs, and “what if” scenarios about current and potential future health states and treatments; 5) implementing choices (e.g., providing transportation) and addressing “spillover” decisions (e.g., work arrangements) resulting from medical treatment choices; and 6) making upstream healthcare decisions on behalf of patients who preferred to have decisions made by their family caregivers. Conclusions: These data highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early palliative care decision support interventions for family caregivers.
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Affiliation(s)
| | - Deborah Ejem
- University of Alabama at Birmingham, Birmingham, AL
| | - Rachel Wells
- University of Alabama at Birmingham, Birmingham, AL
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Wells R, Dionne-Odom J NJ, Pamboukian S, Tallaj J, Azuero A, Keebler K, Ejem D, Kvale E, Swetz K, Steinhauser K, Durant R, Kono A, Bakitas M. Implementation challenges of conducting a heart failure palliative care intervention pilot trial in the deep south. Heart Lung 2018. [DOI: 10.1016/j.hrtlng.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wells R, Dionne-Odom NJ, Pamboukian S, Tallaj J, Azuero A, Keebler K, Ejem D, Kvale E, Swetz K, Steinhauser K, Durant R, Kono A, Bakitas M. Describing evaluations and treatment recommendations performed during outpatient palliative care consultations for individuals with advanced heart failure. Heart Lung 2018. [DOI: 10.1016/j.hrtlng.2018.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wells R, Ejem D, Dionne-Odom JN, Bagcivan G, Keebler K, Frost J, Azuero A, Kono A, Swetz KM, Bakitas M. Protocol driven palliative care consultation: Outcomes of the ENABLE CHF-PC pilot study. Heart Lung 2018; 47:533-538. [PMID: 30143363 DOI: 10.1016/j.hrtlng.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little has been reported about protocol-driven outpatient palliative care consultation (OPCC) for advanced heart failure (HF). OBJECTIVES To describe evaluation practices and treatment recommendations made during protocol-driven OPCCs for advanced HF. METHODS We performed content analysis of OPCCs completed as part of ENABLE CHF-PC, an early palliative care HF intervention, conducted at sites in the Northeast and Southeast. T-tests, Fisher's exact, and Chi-square tests were used to evaluate sociodemographic, outcome measures, and site content differences. RESULTS Of 61 ENABLE CHF-PC participants, 39 (64%) had an OPCC (Northeast, n=27; Southeast, n=12). Social and medical history assessed most were close relationships (n=35, 90%), family support (n=33, 85%), advance directive status (n=33, 85%), functional status (n=30, 77%); and symptoms were mood (n= 35, 90%), breathlessness (n=28, 72%), and chest pain (n=24, 62%). Treatment recommendations focused on care coordination (n=13, 33%) and specialty referrals (n=12, 31%). Between-site OPCC differences included assessment of family support (Northeast vs. Southeast: 100% vs. 50%), code status (96% vs. 58%), goals of care discussions (89% vs. 41.7%), and prognosis understanding (85% vs. 33%). CONCLUSION OPCCs for HF focused on evaluating medical and social history, along with goals of care and code status discussions. Symptom evaluation commonly included mood disorders, pain, dyspnea, and fatigue. Notable regional differences were found in topics evaluated and OPCC completion rates.
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Affiliation(s)
- Rachel Wells
- School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA.
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - Gulcan Bagcivan
- School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - Jennifer Frost
- School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - Alan Kono
- Cardiology, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Heart and Vascular Center DHMC, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Keith M Swetz
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB Center for Palliative & Supportive Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0012, USA; Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA; Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB Center for Palliative & Supportive Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0012, USA
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22
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Dionne-Odom JN, Ejem D, Azuero A, Taylor RA, Rocque GB, Turkman Y, Thompson MA, Knight SJ, Martin MY, Bakitas MA. Factors Associated with Family Caregivers' Confidence in Future Surrogate Decision Making for Persons with Cancer. J Palliat Med 2018; 21:1705-1712. [PMID: 30129873 DOI: 10.1089/jpm.2018.0148] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Improving family caregiver preparation for surrogate decision making is a critical priority. Objective: Determine a parsimonious set of intrapersonal factors associated with family caregivers' confidence in making future medical decisions for their relatives with cancer. Methods: Cross-sectional mail survey. Family caregivers of Medicare beneficiaries with pancreatic, lung, brain, ovarian, head and neck, hematologic, and stage IV cancers from communities of eight U.S. cancer centers. Participants completed validated measures of their social and mental health, self-care behaviors, coping styles, and surrogate decision-making confidence. Using linear modeling, the Bayesian information criterion was used to identify factors associated with decision-making confidence. A bootstrap approach was used to conduct penalized inference on the selected model coefficients. Model fit validation was assessed with a random forest ensemble. Results: Caregivers (n = 294) were on average 65.5 years old, mostly female (72.8%), and care recipients' spouse/partner (60.2%). The parsimonious set of factors associated with low caregiver decision-making confidence included less engagement in spiritual growth self-care, more use of avoidant coping, low emotional social support, and younger care recipient age (in-sample R2 = 0.22). These factors were also identified by a random forest approach. After overfitting adjustment (shrunken R2 = 0.09), the strongest associations with low surrogate decision-making confidence were low spiritual growth self-care (adjusted standardized B = 0.17, p = 0.005) and high use of avoidant coping (adjusted standardized B = -0.12, p = 0.049). Discussion: Identifying strategies to enhance spiritual growth and reduce avoidant coping may be promising targets for interventions to improve family caregivers' confidence in future surrogate decision making.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yasemin Turkman
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Moneka A Thompson
- Department of Pastoral Care, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sara J Knight
- Department of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
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23
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Wells R, Stockdill ML, Dionne-Odom JN, Ejem D, Burgio KL, Durant RW, Engler S, Azuero A, Pamboukian SV, Tallaj J, Swetz KM, Kvale E, Tucker RO, Bakitas M. Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare for Patients and Caregivers (ENABLE CHF-PC): study protocol for a randomized controlled trial. Trials 2018; 19:422. [PMID: 30081933 PMCID: PMC6090835 DOI: 10.1186/s13063-018-2770-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Palliative care is specialized medical care for people with serious illness that is focused on providing relief from symptoms and stress and improving the quality of life (QOL) for patients and their families. To help the 6.5 million U.S. adults and families affected by heart failure manage the high symptom burden, complex decision-making, and risk of exacerbation and death, the early integration of palliative care is critical and has been recommended by numerous professional organizations. However, few trials have tested early outpatient community-based models of palliative care for patients diagnosed with advanced heart failure and their caregivers. To address this gap, through a series of formative evaluation trials, we translated an oncology early palliative care telehealth intervention for heart failure to create ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends, Comprehensive Heartcare for Patients and Caregivers). METHODS/DESIGN The primary objective of this multisite pragmatic randomized controlled trial is to test the efficacy of ENABLE CHF-PC plus usual heart failure care compared to usual care alone. Community-dwelling persons who are ≥50 years of age with New York Heart Association class III/IV or American Heart Association/American College of Cardiology stage C/D heart failure and their primary caregiver (if present) are being randomized to one of two study arms. The ENABLE CHF-PC intervention group receives usual heart failure care plus an in-person palliative care assessment by a board-certified palliative care provider (caregivers are invited to attend), a series of nurse coach-led, weekly psychoeducational 20 to 60 min phone sessions using a guidebook called Charting Your Course (patients: 6 sessions and caregivers: 4 sessions), and monthly check-in calls. Charting Your Course topical content includes problem-solving, coping, self-care and symptom management, communication, decision-making, advance care planning, and life review (patients only). Primary outcomes include patient QOL and mood (depressive symptoms/anxiety) and caregiver QOL, mood, and burden at 8 and 16 weeks after baseline. Outcomes will be examined using an intention-to-treat approach and mixed effects modeling for repeated measures. DISCUSSION This trial will determine whether the ENABLE CHF-PC model of concurrent heart failure palliative care is superior to usual heart failure care alone in achieving higher patient and caregiver QOL, improving mood, and lowering burden. TRIAL REGISTRATION ClinicalTrials.gov, NCT02505425 . Registered on 22 July 2015.
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Affiliation(s)
- Rachel Wells
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Macy L. Stockdill
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Kathryn L. Burgio
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
- Birmingham VA Medical Center, VAMC 11G, 700 19th St South, Birmingham, AL 35233-0001 USA
| | - Raegan W. Durant
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Salpy V. Pamboukian
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Keith M. Swetz
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Elizabeth Kvale
- Department of Medicine, Dell Medical School, University of Texas at Austin, 1501 Red River Street, Austin, TX 78712 USA
| | - Rodney O. Tucker
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-2041 USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
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24
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Ejem D, Dionne-Odom JN, Turkman Y, Knight SJ, Willis D, Kaufman PA, Bakitas M. Incongruence between women's survey- and interview-determined decision control preferences: A mixed methods study of decision-making in metastatic breast cancer. Psychooncology 2018; 27:1950-1957. [DOI: 10.1002/pon.4747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Deborah Ejem
- School of Nursing; University of Alabama at Birmingham; Birmingham AL USA
| | | | - Yasemin Turkman
- School of Nursing; University of Alabama at Birmingham; Birmingham AL USA
| | - Sara J. Knight
- Department of Preventive Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - Dan Willis
- School of Nursing; University of Wisconsin-Madison; Madison WI USA
| | - Peter A. Kaufman
- Section of Hematology Oncology; Dartmouth-Hitchcock Medical Center; Lebanon NH USA
| | - Marie Bakitas
- School of Nursing; University of Alabama at Birmingham; Birmingham AL USA
- Department of Medicine; Division of Geriatrics, Gerontology, and Palliative Medicine; Birmingham AL USA
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25
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Abstract
Informal caregivers play a vital role in supporting seriously ill patients. However, informal caregiving is burdensome and can lead to negative health outcomes for the caregiver and the care recipient. The study's aim was to evaluate relationships among caregiver burden, care recipient depressive symptomology, and race. Guided by the social exchange perspective, we examined cross-sectional dyadic data from the National Long-Term Care Survey (N = 1279). Using ordinal logistic regression, we found that higher caregiver-reported objective burden was associated with higher care recipient depressive symptoms ( P < .05), an association that was stronger for blacks. Interestingly, despite significant levels of objective burden, there was an association between lower depressive symptoms in black care recipients when there was an exchange of the social good "helpful company" with a caregiver. These findings illustrate the importance of supporting reciprocal exchange as a promising component of maintaining balanced caregiver-care recipient relationships among black older adults and their informal caregivers.
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Affiliation(s)
- Deborah Ejem
- 1 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shawn Bauldry
- 2 Department of Sociology, Purdue University, West Lafayette, IN, USA
| | - Marie Bakitas
- 1 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.,3 Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patricia Drentea
- 4 Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
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26
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Gok Metin Z, Ejem D, Dionne-Odom JN, Turkman Y, Salvador C, Pamboukian S, Bakitas M. Mind-Body Interventions for Individuals With Heart Failure: A Systematic Review of Randomized Trials. J Card Fail 2017; 24:186-201. [PMID: 28939458 DOI: 10.1016/j.cardfail.2017.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/08/2017] [Accepted: 09/15/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The effects of mind-body interventions (MBIs) (eg, Tai Chi, yoga, meditation) for individuals with heart failure (HF) have not been systematically evaluated. METHODS AND RESULTS We performed a systematic review of randomized controlled trials (RCTs) examining the effects of MBIs in HF. We extracted participant characteristics, MBI procedure, outcomes assessed, and main results of English-language RCTs before October 2016. We identified 24 RCTs (n = 1314 participants) of 9 MBI types: Tai Chi (n = 7), yoga (n = 4), relaxation (n = 4), meditation (n = 2), acupuncture (n = 2), biofeedback (n = 2), stress management (n = 1), Pilates (n = 1), and reflexology (n = 1). Most (n = 22, 95.8%) reported small-to-moderate improvements in quality of life (14/14 studies), exercise capacity (8/9 studies), depression (5/5 studies), anxiety and fatigue (4/4 studies), blood pressure (3/5 studies), heart rate (5/6 studies), heart rate variability (7/9 studies), and B-type natriuretic peptide (3/4 studies). Studies ranged from 4 minutes to 26 weeks and group sizes ranged from 8 to 65 patients per study arm. CONCLUSIONS Although wide variability exists in the types and delivery, RCTs of MBIs have demonstrated small-to-moderate positive effects on HF patients' objective and subjective outcomes. Future research should examine the mechanisms by which different MBIs exert their effects.
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Affiliation(s)
- Zehra Gok Metin
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
| | | | - Yasemin Turkman
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carolina Salvador
- Department of Medicine, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Salpy Pamboukian
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham; Birmingham, Alabama
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
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27
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Nicholas Dionne-Odom J, Hooker SA, Bekelman D, Ejem D, McGhan G, Kitko L, Strömberg A, Wells R, Astin M, Metin ZG, Mancarella G, Pamboukian SV, Evangelista L, Buck HG, Bakitas MA. Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review. Heart Fail Rev 2017; 22:543-557. [PMID: 28160116 PMCID: PMC5544594 DOI: 10.1007/s10741-017-9597-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Many of the 23 million individuals with heart failure (HF) worldwide receive daily, unpaid support from a family member or friend. Although HF and palliative care practice guidelines stipulate that support be provided to family caregivers, the evidence base to guide care for this population has not been comprehensively assessed. In order to appraise the state-of-the-science of HF family caregiving and recommend areas for future research, the aims of this review were to summarize (1) how caregivers influence patients, (2) the consequences of HF for caregivers, and (3) interventions directed at HF caregivers. We reviewed all literature to December 2015 in PubMed and CINAHL using the search terms "heart failure" AND "caregiver." Inclusion criteria dictated that studies report original research of HF family caregiving. Articles focused on children or instrument development or aggregated HF with other illnesses were excluded. We identified 120 studies, representing 5700 caregivers. Research on this population indicates that (1) caregiving situations vary widely with equally wide-ranging tasks for patients to help facilitate their health behaviors, psychological health and relationships, and quality of life (QoL); (2) caregivers have numerous unmet needs that fluctuate with patients' unpredictable medical status, are felt to be ignored by the formal healthcare system, and can lead to distress, burden, and reduced QoL; and (3) relatively few interventions have been developed and tested that effectively support HF family caregivers. We provide recommendations to progress the science forward in each of these areas that moves beyond descriptive work to intervention development and clinical trials testing.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA.
| | - Stephanie A Hooker
- Department of Psychology, University of Colorado, Denver, Campus Box 173, PO Box 173364, Denver, CO, 80217, USA
| | - David Bekelman
- Veterans Affairs Eastern Colorado Health Care System, Department of Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, 1055 Clermont Street, Research 151, Denver, CO, 80220, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Gwen McGhan
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Lisa Kitko
- College of Nursing, Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA, 16802, USA
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing, Campus University Hospital, Linköping University, Building 511-001, 581 85, Linköping, Sweden
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Meka Astin
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Zehra Gok Metin
- Department of Internal Medicine Nursing, Hacettepe University, 06100, Ankara, Turkey
| | - Gisella Mancarella
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Salpy V Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 1900 University Blvd, THT 321, Birmingham, AL, 35294, USA
| | - Lorraine Evangelista
- Program in Nursing Science, University of California, Irvine, 299E Berk Hall, Irvine, CA, 92697-3959, USA
| | - Harleah G Buck
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd. MDC22, Tampa, FL, 33612-4766, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
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28
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Bakitas M, Dionne-Odom JN, Pamboukian SV, Tallaj J, Kvale E, Swetz KM, Frost J, Wells R, Azuero A, Keebler K, Akyar I, Ejem D, Steinhauser K, Smith T, Durant R, Kono AT. Engaging patients and families to create a feasible clinical trial integrating palliative and heart failure care: results of the ENABLE CHF-PC pilot clinical trial. BMC Palliat Care 2017; 16:45. [PMID: 28859648 PMCID: PMC5580310 DOI: 10.1186/s12904-017-0226-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/01/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Early palliative care (EPC) is recommended but rarely integrated with advanced heart failure (HF) care. We engaged patients and family caregivers to study the feasibility and site differences in a two-site EPC trial, ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare for Patients and Caregivers). METHODS We conducted an EPC feasibility study (4/1/14-8/31/15) for patients with NYHA Class III/IV HF and their caregivers in academic medical centers in the northeast and southeast U.S. The EPC intervention comprised: 1) an in-person outpatient palliative care consultation; and 2) telephonic nurse coach sessions and monthly calls. We collected patient- and caregiver-reported outcomes of quality of life (QOL), symptom, health, anxiety, and depression at baseline, 12- and 24-weeks. We used linear mixed-models to assess baseline to week 24 longitudinal changes. RESULTS We enrolled 61 patients and 48 caregivers; between-site demographic differences included age, race, religion, marital, and work status. Most patients (69%) and caregivers (79%) completed all intervention sessions; however, we noted large between-site differences in measurement completion (38% southeast vs. 72% northeast). Patients experienced moderate effect size improvements in QOL, symptoms, physical, and mental health; caregivers experienced moderate effect size improvements in QOL, depression, mental health, and burden. Small-to-moderate effect size improvements were noted in patients' hospital and ICU days and emergency visits. CONCLUSIONS Between-site demographic, attrition, and participant-reported outcomes highlight the importance of intervention pilot-testing in culturally diverse populations. Observations from this pilot feasibility trial allowed us to refine the methodology of an in-progress, full-scale randomized clinical efficacy trial. TRIAL REGISTRATION Clinicaltrials.gov NCT03177447 (retrospectively registered, June 2017).
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Affiliation(s)
- Marie Bakitas
- School of Nursing and Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA. .,School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA.
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Kvale
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keith M Swetz
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Frost
- Cardiology, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Imatullah Akyar
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA.,Faculty of Health Sciences, Nursing Department, Hacettepe University, Ankara, Turkey
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Karen Steinhauser
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Tasha Smith
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Raegan Durant
- Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan T Kono
- Cardiology, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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29
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Rice M, Turner-Henson A, Hage FG, Azuero A, Joiner C, Affuso O, Ejem D, Davis SL, Soistmann H. Factors That Influence Blood Pressure in 3- to 5-Year-Old Children: A Pilot Study. Biol Res Nurs 2017; 20:25-31. [DOI: 10.1177/1099800417726598] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While incident elevations in blood pressure (BP) are apparent in preschool years, factors influencing BP in this population have received little attention. The purposes of this pilot study were to determine the feasibility of collecting data from preschoolers and their mothers and to determine effect sizes of relationships between BP and sex, race, birth status, body mass index (BMI), waist circumference (WC), geographic location, serum C-reactive protein (CRP), and salivary cortisol (morning, afternoon). A hypothesis-generating correlational design was used; 56 children, aged 3–5 years, were enrolled from six rural and urban Head Start programs in a southeastern state. On Day 1 of data collection, mothers completed demographic questionnaires and children had blood drawn by finger stick. On Day 2, children gave saliva samples for cortisol, were measured for height by stadiometer, weight by digital scales, and WC by tape measure and had their BP measured by Dinamap. Incident elevations in BP were found in 30% of children (17/56), the majority of which were of systolic BP; 65% of those with elevations were of normal weight. Data collection was feasible with few problems. Small-to-medium effect sizes were noted for BP status (normal, prehypertensive, and hypertensive) and cortisol p.m. and birth status (parent-reported prematurity or term); small effect sizes were seen for BP status and BMI, race, sex, and geographic location. CRP and cortisol had medium- and small-to-medium effect sizes, respectively, with diastolic blood pressure. Studies with larger, more diverse samples need to be conducted to test hypotheses posited from these estimated effect sizes.
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Affiliation(s)
- Marti Rice
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anne Turner-Henson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fadi G. Hage
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia Joiner
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olivia Affuso
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Heather Soistmann
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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30
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Wells R, Dionne-Odom JN, Pamboukian S, Tallaj J, Azuero A, Keebler K, Ejem D, Kvale E, Swetz K, Steinhauser K, Durant R, Kono A, Bakitas M. Implementation Challenges of Conducting a Heart Failure Palliative Care Intervention Pilot Trial Below the Mason-Dixon Line. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Clay O, Ejem D, Waters M. A PROFILE OF AFRICAN AMERICAN CAREGIVERS FOR FAMILY MEMBERS WITH MEMORY PROBLEMS IN THE DEEP SOUTH. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O.J. Clay
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - D. Ejem
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - M.M. Waters
- The University of Alabama at Birmingham, Birmingham, Alabama
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Dionne-Odom JN, Demark-Wahnefried W, Taylor RA, Rocque GB, Azuero A, Acemgil A, Martin MY, Astin M, Ejem D, Kvale E, Heaton K, Pisu M, Partridge EE, Bakitas MA. The self-care practices of family caregivers of persons with poor prognosis cancer: differences by varying levels of caregiver well-being and preparedness. Support Care Cancer 2017; 25:2437-2444. [PMID: 28247128 DOI: 10.1007/s00520-017-3650-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 10/27/2016] [Accepted: 02/17/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Little is known about the impact of family caregiving for adults with poor prognosis cancer on caregivers' own individual self-care practices. We explored differences in caregivers' discrete self-care practices associated with varying levels of caregiver well-being, preparedness, and decision-making self-efficacy. METHODS Cross-sectional survey within eight community-based southeastern U.S. cancer centers was conducted. Family caregivers of Medicare beneficiaries ≥65 years with pancreatic, lung, brain, ovarian, head and neck, hematologic, or stage IV cancer completed measures of individual self-care practices (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and sleep), well-being (anxiety, depression, and health-related quality of life [HRQoL]), preparedness, and decision-making self-efficacy. RESULTS Caregivers (n = 294) averaged 66 years, were mostly female (72.8%), white (91.2%), Protestant (76.2%), retired (54.4%), and patients' spouse/partner (60.2%). Approximately, half were rural-dwellers (46.9%) with incomes <$50,000 (53.8%). Most provided support 6-7 days/week (71%) for >1 year (68%). Nearly a quarter (23%) reported high depression and 34% reported borderline or high anxiety. Low engagement in all self-care practices was associated with worse caregiver anxiety, depression, and mental HRQoL (all p values < .05). Caregivers with lower health responsibility, spiritual growth, interpersonal relation, and stress management scores had lower preparedness and decision-making self-efficacy. CONCLUSIONS A significant proportion of caregivers simultaneously report low engagement in all forms of self-care practices, high depression and anxiety, and low HRQoL mental health scores. Caregiver well-being, preparedness, and decision-making self-efficacy might be optimized through interventions targeted at enhancing health responsibility, stress management, interpersonal relationships, and spiritual growth self-care practices.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA.
| | | | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Gabrielle B Rocque
- UAB Comprehensive Cancer Center, 1824 6th Avenue South, Birmingham, AL, 35233, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Aras Acemgil
- Department of Preventive Medicine, UAB, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN, 38163, USA
| | - Meka Astin
- School of Nursing, University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Elizabeth Kvale
- Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, UAB Center for Palliative and Supportive Care, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Karen Heaton
- School of Nursing, University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Maria Pisu
- Department of Preventive Medicine, UAB, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Edward E Partridge
- UAB Comprehensive Cancer Center, 1824 6th Avenue South, Birmingham, AL, 35233, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA.,Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, UAB Center for Palliative and Supportive Care, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
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Ghazi L, Dudenbostel T, Xing D, Ejem D, Turner-Henson A, Joiner CI, Affuso O, Azuero A, Oparil S, Calhoun DA, Rice M, Hage FG. Assessment of vascular function in low socioeconomic status preschool children: a pilot study. ACTA ACUST UNITED AC 2017; 11:101-109. [PMID: 28063813 DOI: 10.1016/j.jash.2016.12.006] [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] [Received: 08/29/2016] [Revised: 11/18/2016] [Accepted: 12/12/2016] [Indexed: 12/17/2022]
Abstract
Elevated brachial blood pressure (BP) in childhood tracks into adulthood. Central BP and measures of arterial stiffness, such as aortic augmentation index (AIx) and pulse wave velocity (PWV), have been associated with future cardiovascular disease. This pilot study assessed the feasibility of noninvasively measuring these parameters in preschool children and explored factors that may be associated with elevated BP in this age group. Brachial BP was measured using an electronic oscillometric unit (Dinamap PRO 100) and defined as elevated when systolic BP (SBP) and/or diastolic BP (DBP) was ≥ the 90th percentile for age, gender, and height. Central BP, AIx, and PWV were measured using applanation tonometry (SphygmoCor). C-reactive protein (CRP) was measured in serum samples. Sixteen African-American preschool children were recruited (4.4 ± 0.8 years, 69% males), 6 (38%) of whom had an elevated brachial BP (110 ± 10/69 ± 4 vs. 96 ± 8/55 ± 6 mm Hg, Cohen's d = 2.2). Children with elevated brachial BP had higher central SBP (d = 1.6) and DBP (d = 1.96) (97 ± 6/68 ± 4 vs. 85 ± 8/57 ± 6 mm Hg), AIx (d = 0.88) (31 ± 8 vs. 18 ± 16%, standardized to heart rate), and CRP (3.1 [2.3-6.3] vs. 0.1 [0.1-0.3] mg/dL, d = 2). There was no significant difference in PWV between groups (d = 0.26). CRP and SBP (Spearman r = 0.70), DBP (r = 0.68), central SBP (r = 0.58), and central DBP (r = 0.71) were positively correlated. Wide confidence intervals for the estimated effect sizes indicated a large degree of uncertainty about all estimates due to the small sample size. Noninvasive assessment of central BP and arterial stiffness is feasible in preschool children. Vascular inflammation may be an important factor that influences BP at an early age. Further studies in preschool children are needed to elucidate mechanisms of early onset hypertension.
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Affiliation(s)
- Lama Ghazi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Tanja Dudenbostel
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Daisy Xing
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, AL, USA
| | | | - Cynthia Irwin Joiner
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Olivia Affuso
- School of Public Health, University of Alabama at Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, AL, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - David A Calhoun
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Marti Rice
- University of Alabama at Birmingham, AL, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL, USA; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Dionne-Odom JN, Demark-Wahnefried W, Taylor RA, Rocque GB, Azuero A, Acemgil A, Martin MY, Astin M, Ejem D, Kvale EA, Heaton K, Pisu M, Partridge EE, Bakitas M. Differences in self-care behaviors by varying levels of caregiving intensity, performance, and well-being among family caregivers of patients with high-mortality cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.26_suppl.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
239 Background: Family caregivers of high-mortality cancer patients perform vital tasks that deter from their own self-care. We aimed to determine differences in self-care behaviors by varying levels of caregiving intensity, well-being, and performance. Methods: Cross-sectional survey conducted in community settings of 8 cancer centers in AL, FL, and TN. Two-hundred and ninety-four family caregivers of Medicare beneficiaries diagnosed with pancreatic, lung, brain, ovarian, head & neck, hematologic, or stage IV cancer completed measures of self-care behaviors, including health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and sleep; anxiety and depression; health-related quality of life (HRQoL); caregiver competence and preparedness; and decision-making self-efficacy. Results: Caregivers averaged 66 years and were mostly female (72.8%), white (91.2%), Protestant (76.2%), retired (54.4%) and patients’ spouse/partner (60.2%). Approximately half were rural-dwellers (46.9%) and had incomes <$50,000 (53.8%). The majority provided support 6-7 days per week (71%) for > 1 year (68%). Lower self-care behavior scores were associated with longer durations, higher hours, and more days/week of caregiving and with fair or poor patient health. Worse caregiver anxiety, depression, and mental HRQoL scores were significantly associated with lower scores in every self-care subdomain (all ps < .05). Nearly a quarter of respondents reported high depression scores (23%) and 34% reported borderline or high anxiety scores. Caregivers with lower competence, preparedness, and decision-making efficacy had lower spiritual growth, interpersonal relation, and stress management scores. Conclusions: Higher caregiving intensity is associated with worse caregiver self-care. Poorer self-care in all domains is associated with worse caregiver well-being. Interventions to optimize caregiver wellbeing should target all self-care behaviors and to optimize caregiver performance should target spiritual growth, interpersonal relation, and stress management self-care behaviors.
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Affiliation(s)
| | | | | | | | - Andres Azuero
- The University of Alabama at Birmingham, Birmingham, AL
| | - Aras Acemgil
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Meka Astin
- University of Alabama at Birmingham, Birmingham, AL
| | - Deborah Ejem
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Karen Heaton
- University of Alabama at Birmingham, Birmingham, AL
| | - Maria Pisu
- University of Alabama at Birmingham, Birmingham, AL
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Ejem D, Dionne-Odom JN, Willis D, Kaufman P, Urquhart L, Bakitas M. Differences between women’s preferred and actual experience with ‘shared decision-making’: A mixed method study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.26_suppl.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
34 Background: Women with metastatic breast cancer (MBC) face numerous treatment and ACP decisions along their illness trajectory. We aimed to explore the treatment and ACP decision-making processes and decision support needs of women with MBC. Methods: Convergent, parallel mixed methods study (9/08-7/09). Sample included women with MBC managed by 3 breast oncologists at the Norris Cotton Cancer Center, Lebanon, NH. Participants completed a semi-structured interview and standardized decision-making instruments (decision control preferences) at study enrollment (T1; n = 22) and when they faced a decision point or 3 months later (T2; n = 19), whichever came first. Results: Participants (n = 22) where all white, averaged 62 years and were mostly married (54%), retired (45%), had a ≥ bachelor’s degree (45%), and had incomes > $40,000 (50%). On the control preferences scale, most women reported a preference for a ‘shared decision’ with clinician (T1 = 14 (64%) vs T2 = 9 (47%)) compared to making the decision themselves (T1 = 6 (27%) vs T2 = 6 (32%)), or delegating the decision to their doctor (T1 = 2 (9%) vs T2 = 4 (21%)). In semi-structured interviews about their actual treatment decision-making experience, women described experiencing a passive or delegated rather than a shared decision-making process. Conversely, women described a much more active ACP decision-making process that was often shared with family rather than their oncologists. Conclusions: Women selected a “shared” process using a validated tool; however their descriptions of the treatment decision-making processes were inconsistent with their actual experience, which was a more passive process in which they followed the oncologists’ treatment suggestions.
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Affiliation(s)
- Deborah Ejem
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Danny Willis
- Connel School of Nursing, Boston College, Chestnut Hill, MA
| | - Peter Kaufman
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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