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Laidsaar-Powell R, Giunta S, Butow P, Turner S, Costa D, Saunders C, Koczwara B, Kay J, Jefford M, Schofield P, Boyle F, Yates P, White K, Sundaresan P, Varadarajan S, Juraskova I. An online intervention to improve oncology health professional self-efficacy in communicating with carers: Hybrid effectiveness-implementation evaluation of the eTRIO program. Patient Educ Couns 2024; 124:108251. [PMID: 38626502 DOI: 10.1016/j.pec.2024.108251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES Many oncology health professionals (HPs) report communicating with carers as complex; and receive limited carer-relevant training. We developed an online HP education program for supporting and managing carer involvement (eTRIO). We aimed to assess whether HPs' self-efficacy in carer communication, knowledge, and decision-making preferences improve following eTRIO. Satisfaction and implementation potential were assessed. METHODS This type 1 hybrid effectiveness-implementation study used a pre-post single arm intervention design. HPs completed baseline measures, the eTRIO online module, and measures at 1- and 12-weeks post-intervention. Measures included: self-efficacy in carer communication (13-items), applied knowledge (7-items), preference for carer involvement in decisions (1-item). Fifteen of participants completed feedback interviews which underwent thematic analysis. User analytics were collected and analysed. RESULTS Fifty-six HPs completed baseline measures, 42 completed post- and follow-up measures. At baseline mean self-efficacy score was 88. HPs showed a statistically significant increase in self-efficacy post-intervention (mean = 105.8, CI [12.99, 20.47]), maintained at 12-weeks (mean = 101.1, CI [8.00, 15.72]). There were no changes in knowledge or decision-making preferences. Program engagement and satisfaction were high, 86.7% participants rated eTRIO as very/extremely helpful. CONCLUSIONS AND PRACTICE IMPLICATIONS eTRIO provided HPs with confidence to effectively engage with carers and manage complex situations such as family dominance. These gains are noteworthy, as conflict with families/carers contributes to HP burnout.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia; School of Psychology, University of Sydney, Australia.
| | - Sarah Giunta
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia; School of Psychology, University of Sydney, Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia
| | - Sandra Turner
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Australia
| | - Daniel Costa
- School of Psychology, University of Sydney, Australia
| | - Christobel Saunders
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Bogda Koczwara
- Flinders Medical Centre, Adelaide, Australia; Flinders University, Adelaide, Australia
| | - Judy Kay
- School of Computer Science, The University of Sydney, Sydney, Australia
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Penelope Schofield
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Psychology, and Iverson Health Innovation Research Institute Swinburne University, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Australia; Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, Sydney, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kate White
- Susan Wakil School of Nursing, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Puma Sundaresan
- Trans Tasman Radiation Oncology Group, New South Wales, Australia; Sydney West Radiation Oncology Network, WSLHD, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Suganthy Varadarajan
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia; Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia; Psycho-Oncology Co-operative Research Group, University of Sydney, Australia; School of Psychology, University of Sydney, Australia
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Backhouse T, Jeon YH, Killett A, Green J, Khondoker M, Mioshi E. Nurturing Attentiveness: A Naturalistic Observation Study of Personal Care Interactions Between People With Advanced Dementia and Their Caregivers. Gerontologist 2024; 64:gnae004. [PMID: 38267689 PMCID: PMC11102004 DOI: 10.1093/geront/gnae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Personal care interactions can provide vital opportunities for caregivers to engage with a person living with advanced dementia. However, interactions may also be a contentious experience, what makes this so is not fully understood. We aimed to examine features of personal care interactions between caregivers and people with advanced dementia to understand how care may be improved. RESEARCH DESIGN AND METHODS This was a naturalistic observation study using one-off video-recorded observations of personal care interactions between 14 people with advanced dementia and 12 caregivers (n = 7 care-home staff, n = 5 family carers) in the United Kingdom (total observation time 03:01:52). Observations were analyzed with observational video coding to determine the frequency of actions of people with dementia and qualitative content analysis for in-depth examination. RESULTS Refusals of care were present in 32% of video sections. Active engagement of people with dementia was observed in 66% of sections. Rare contentious interactional components were characterized by the person with dementia appearing to show uneasiness and caregivers being flustered and uncertain. However, caregivers typically emanated a nurturing attentiveness, were attuned to the person, and skilled in seamlessly supporting them through care activities. DISCUSSION AND IMPLICATIONS Findings draw on real-world empirical evidence to reinvigorate the notion of person-centeredness in dementia care. The findings provide much needed insight into practical ways to improve care interactions for people with advanced dementia and enhance their personhood. Appropriate training/guidance for caregivers could support positive personal care experiences for both the person with dementia and caregiver.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Yun-Hee Jeon
- Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Jessica Green
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
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Brooks D, Wyles K, Pachana NA, Beattie E, Gaugler JE. Tailored videoconferencing counselling program to support family carers of people living with dementia during the transition to permanent residential care: a pilot and feasibility randomised trial. BMC Geriatr 2024; 24:375. [PMID: 38671367 PMCID: PMC11055339 DOI: 10.1186/s12877-024-04907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Decisions surrounding the permanent residential care placement of people living with dementia can be stressful and distressing; however, providing access to targeted information and support prior to placement may help carers better cope. This mixed methods study aimed to test the feasibility, acceptability, and potential benefits of providing a tailored, individual counselling program (the Residential Care Transition Module), delivered via videoconferencing, to Australian family carers of a relative with dementia during the transition to permanent residential care. METHODS A total of 18 family carers were randomly allocated to receive either the counselling intervention (six sessions delivered over 12 weeks) or a check-in call, delivered by a trained Transition Counsellor. Both groups received help-sheets about residential care, coping with placement, and managing feelings. Carers completed online surveys about stress, guilt, anxiety, depression, grief, and support for caring at baseline and four months post-baseline. Carers were also invited to participate in semi-structured exit interviews, conducted after follow-up surveys were completed. Process data relating to recruitment, retention, intervention dose and delivery were collected via logs. Quantitative data were analysed using descriptive statistics and repeated measures ANOVA. Qualitative data, relating to feasibility, acceptability, and perceived benefits of the program, were analysed using the 'framework' approach developed by the Medical Research Council to inform the process evaluation of complex interventions. RESULTS Qualitative findings indicated that delivery of the counselling program during the transition period was deemed by participants to be feasible and acceptable. Delivery via videoconferencing was deemed convenient and acceptable, with few technical issues. The skills and knowledge of the Transition Counsellor were perceived to be important mechanisms of impact. Though not statistically significant, promising quantitative findings were identified in terms of reduced carer stress and guilt and improved support for caring. CONCLUSIONS Delivery of a tailored counselling program via videoconferencing to family carers of people living with dementia during the transition to residential care was feasible and acceptable. The program has the potential to improve transitional support to family carers. TRIAL REGISTRATION This study was registered in the Australian New Zealand Clinical Trials Registry: ACTRN12621001462875.
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Affiliation(s)
- Deborah Brooks
- School of Nursing, Queensland University of Technology, Brisbane, Australia.
- The University of Queensland Centre for Clinical Research, Brisbane, Australia.
| | - Katy Wyles
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Joseph E Gaugler
- School of Psychology, The University of Queensland, Brisbane, Australia
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Kolade OR, Porat-Dahlerbruch J, Makhmutov R, van Achterberg T, Ellen ME. Strategies for engaging older adults and informal caregivers in health policy development: A scoping review. Health Res Policy Syst 2024; 22:26. [PMID: 38374133 PMCID: PMC10875823 DOI: 10.1186/s12961-024-01107-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Care for older adults is high on the global policy agenda. Active involvement of older adults and their informal caregivers in policy-making can lead to cost-effective health and long-term care interventions. Yet, approaches for their involvement in health policy development have yet to be extensively explored. This review maps the literature on strategies for older adults (65+ years) and informal caregivers' involvement in health policy development. METHOD As part of the European Union TRANS-SENIOR program, a scoping review was conducted using the Joanna Briggs Institute's methodology. Published and grey literature was searched, and eligible studies were screened. Data were extracted from included studies and analysed using the Multidimensional Framework for Patient and Family Engagement in Health and Healthcare. RESULTS A total of 13 engagement strategies were identified from 11 publications meeting the inclusion criteria. They were categorized as "traditional", "deliberative" and "others", adopting the World Bank's categorization of engagement methods. Older adults and informal caregivers are often consulted to elicit opinions and identify priorities. However, their involvement in policy formulation, implementation and evaluation is unclear from the available literature. Findings indicate that older adults and their informal caregivers do not often have equal influence and shared leadership in policy-making. CONCLUSION Although approaches for involving older adults and their informal caregivers' involvement were synthesized from literature, we found next to no information about their involvement in policy formulation, implementation and evaluation. Findings will guide future research in addressing identified gaps and guide policy-makers in identifying and incorporating engagement strategies to support evidence-informed policy-making processes that can improve health outcomes for older adults/informal caregivers.
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Affiliation(s)
- Opeyemi Rashidat Kolade
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, KU Leuven, Kapucijnenvoer 35, 3000, Louvain, Belgium
| | - Joshua Porat-Dahlerbruch
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Rustem Makhmutov
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Theo van Achterberg
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, KU Leuven, Kapucijnenvoer 35, 3000, Louvain, Belgium
| | - Moriah Esther Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Linden MA, Leonard R, Forbes T, Brown M, Marsh L, Todd S, Hughes N, Truesdale M. Randomised controlled feasibility study protocol of the Carers-ID online intervention to support the mental health of family carers of people with intellectual disabilities. Pilot Feasibility Stud 2024; 10:25. [PMID: 38321576 PMCID: PMC10845768 DOI: 10.1186/s40814-024-01448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Family carers play a crucial role in supporting the health and well-being of people with intellectual disabilities. Given their role and responsibilities, many family carers experience significant and ongoing stress and mental health difficulties. Programmes and interventions which provide training and support to family carers have been shown to have a positive impact on levels of stress and quality of life. However, these are often face to face which can create barriers to full participation. Online interventions have been shown to offer flexibility in delivery compared with traditional face-to-face approaches. The primary objective of this study is to determine the feasibility of delivering the Carers-ID online intervention, while the secondary outcome is improved mental health in family carers of people with intellectual disabilities. METHODS Family carers (n = 120) will be randomised to receive the intervention (n = 60) or assigned to a wait-list control (n = 60) group. The intervention ( www.Carers-ID.com ) consists of 14 modules which cover topics including the following: promoting resilience, providing peer support, reducing anxiety, managing stress, accessing local supports and managing family conflict and information for siblings who are carers. The intervention has been co-produced with voluntary sector organisations and family carers and tested for acceptability. Primary outcomes for this study include acceptability and feasibility of the outcome measures, recruitment, participation and retention rates and effect sizes. Secondary outcomes will be completed at three time points (baseline, following intervention completion and 3 months after completion). These include the following: the Depression, Anxiety and Stress Scale, the Warwick-Edinburgh Mental Well-being Scale, the Resilience Scale and the Social Connectedness Scale Revised. Participants (n = 12) who have taken part in the intervention arm of the research will be invited to participate in semi-structured interviews as part of the process evaluation. DISCUSSION The Carers-ID intervention provides an online resource for family carers to support their mental health and well-being and promote their resilience. It represents an affordable and accessible means of delivering such support. Testing the feasibility of the intervention and related trial procedures is required to determine whether a full-scale randomised controlled trial to evaluate the intervention's effectiveness is warranted. TRIAL REGISTRATION ClinicalTrials.gov : NCT05737823.
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Affiliation(s)
- Mark A Linden
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, Ireland
| | - Rachel Leonard
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, Ireland.
| | - Trisha Forbes
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, Ireland
| | - Michael Brown
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, Ireland
| | - Lynne Marsh
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, Ireland
| | - Stuart Todd
- School of Care Sciences, University of South Wales, Caerleon, Wales
| | - Nathan Hughes
- Department of Sociological Studies, University of Sheffield, Sheffield, England
| | - Maria Truesdale
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Linden M, Leonard R, Forbes T, Brown M, Marsh L, Todd S, Hughes N, Truesdale M. Experiences of UK and Irish family carers of people with profound and multiple intellectual disabilities during the COVID-19 pandemic. BMC Public Health 2023; 23:2475. [PMID: 38082349 PMCID: PMC10714525 DOI: 10.1186/s12889-023-17432-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND People with profound and multiple intellectual disabilities (PMID) have high and intensive support needs that ordinarily place significant strain on family carers. This was further heightened by the removal of many external supports during the COVID-19 pandemic. We sought to explore the experiences of family carers of people with PMID during the COVID-19 pandemic and understand what the longer-term impact might be on their lives. METHODS Focus group interviews (n = 32) were conducted with family carers (n = 126) from the four countries of the UK and the Republic of Ireland. Participants were asked questions relating to their experiences of the COVID-19 pandemic, coping strategies, and challenges faced. All focus groups were conducted using the online platform, Zoom. These were audio recorded, transcribed verbatim and analysed employing inductive thematic analysis. FINDINGS Three main themes were generated from the data including (1.0) COVID-19 as a double-edged sword (2.0), The struggle for support (3.0), Constant nature of caring. These included 11 subthemes. (1.1) 'COVID-19 as a catalyst for change', (1.2) 'Challenges during COVID-19: dealing with change', (1.3) 'Challenges during COVID-19: fear of COVID-19', (1.4); 'The online environment: the new normal' (2.1) 'Invisibility of male carers', (2.2) 'Carers supporting carers', (2.3) 'The only service you get is lip service: non-existent services', (2.4); 'Knowing your rights' (3.1) 'Emotional response to the caring role: Feeling devalued', (3.2) 'Emotional response to the caring role: Desperation of caring', (3.3) 'Multiple demands of the caring role.' CONCLUSIONS The COVID-19 pandemic presented immense challenges to family carers of people with PMID but also provided some opportunities. Families had already struggled to receive many of the supports and services to which they were entitled to only to have these removed at the onset of the pandemic. The experiences of male carers have been largely absent from the literature with this research showing they want to be included in decision making and require tailored support services. Service providers should see the end of the COVID-19 pandemic as providing opportunity to re-examine current provision and design services with family carers. As the direct threat from COVID-19 diminishes and the experiences of those who lived through this period come to the fore, there is a need to re-examine current models and provision of support to family carers to better meet their needs.
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Affiliation(s)
- Mark Linden
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK.
| | - R Leonard
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - T Forbes
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - M Brown
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - L Marsh
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - S Todd
- School of Healthcare Sciences, University of South Wales, Cardiff, UK
| | - N Hughes
- ESRC Centre for Care, Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - M Truesdale
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Montgomery L, Misinde C, Komuhangi A, Kawooya AN, Agaba P, McShane CM, Santin O, Apio J, Jenkins C, Githinji F, MacDonald M, Nakaggwa F, Nanyonga RC. Tackling the escalating burden of care in Uganda: a qualitative exploration of the challenges experienced by family carers of patients with chronic non-communicable diseases. BMC Health Serv Res 2023; 23:1356. [PMID: 38053176 PMCID: PMC10696811 DOI: 10.1186/s12913-023-10337-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Family carers face challenges that could significantly affect their health and the health of those they care for. However, these challenges are not well documented in low-income settings, including Uganda. We explored the challenges of caring for someone with chronic non-communicable disease (NCD) in Uganda. METHODS We conducted a qualitative exploratory study at Hospice Africa, Uganda (an urban setting) and Hampton Health Center (a rural setting) in Uganda in February and March 2021. Family carers (n = 44) were recruited using snowball and purposive sampling techniques. Data were collected using focus group discussions and in-depth interviews, gathering family carer perspectives of (a) their caring role (b) their support needs, and (c) attitudes of the wider community. In total, four focus group discussions and 10 individual interviews were completed. RESULTS The average age of carers was 46 years old. The majority of family care was provided by female relatives, who also experienced intersectional disadvantages relating to economic opportunities and employment. Family carers carried a huge burden of care, experiencing significant challenges that affected their physical health, and material and emotional well-being. These challenges also affected the quality of care of the patients for whom they cared. Carers struggled to provide for the basic needs of the patient including the provision of medication and transport to health facilities. Carers received no formal training and limited support to carry out the caring role. They reported that they had little understanding of the patient's illness, or how best to provide care. CONCLUSIONS As NCDs continue to rise globally, the role of family caregivers is becoming more prominent. The need to support carers is an urgent concern. Family carer needs should be prioritised in policy and resource allocation. The need for a carer's toolkit of resources, and the enhancement of community support, have been identified.
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Affiliation(s)
- Lorna Montgomery
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK.
| | - Cyprian Misinde
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Alimah Komuhangi
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Angela N Kawooya
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Peninah Agaba
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | | | - Olinda Santin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Judith Apio
- School of Nursing and Midwifery, Clarke International University, Kampala, Uganda
| | | | - Florence Githinji
- Quality Assurance Office, Clarke International University, Kampala, Uganda
| | - Mandi MacDonald
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Florence Nakaggwa
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Rose C Nanyonga
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Office of the Vice Chancellor, Clarke International University, Kampala, Uganda
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Fox J, Griffith J, Smith AM. Exploring the Efficacy of an Online Training Programme to Introduce Mental Health Recovery to Carers. Community Ment Health J 2023; 59:1193-1207. [PMID: 36826695 PMCID: PMC9950698 DOI: 10.1007/s10597-023-01102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023]
Abstract
Family carers often support people with mental ill-health, however, there is a dearth of research on the importance of recovery to mental health carers. This article describes the delivery and qualitative evaluation of an online training programme on recovery to a group of eleven carers. The participants considered their understanding of the meaning of recovery, differentiating between its personal and clinical nature. They highlighted the importance of carer involvement in the service users' professional support, alongside the need for carers to participate more widely in service development. Finally, the participants found the training useful in enabling them to recognise their own needs in a caring journey, particularly valuing its delivery by a service user and carer trainer. This study is limited by the small number of participants in this programme; however, this series of connected studies suggests its potential to be rolled out more widely, possibly embedded in Recovery Colleges.
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Affiliation(s)
- Joanna Fox
- Anglia Ruskin University, East Road, CB1 1PT, Cambridge, UK.
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Ongko E, Philip J, Zomerdijk N. Perspectives in preparedness of family caregivers of patients with cancer providing end-of-life care in the home: A narrative review of qualitative studies. Palliat Support Care 2023:1-11. [PMID: 37496385 DOI: 10.1017/s1478951523001013] [Citation(s) in RCA: 1] [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] [Indexed: 07/28/2023]
Abstract
BACKGROUND Many patients with advanced cancer identify home as being their preferred place of death. A critical component in achieving a home death is the support of family members, who often take on responsibilities for which they feel insufficiently prepared with subsequent impacts upon their health and well-being. OBJECTIVES This study sought to review existing qualitative literature on family carers' experiences in providing end-of-life care at home for patients with advanced cancer, with an emphasis on exploring factors that influence how prepared they feel for their role. METHODS A narrative review was chosen to provide an overview and analysis of qualitative findings. MEDLINE, PubMed, PsychINFO, and EMBASE databases were searched with the following search terms: "Cancer," "Caregiver," "End of Life Care," "Home," and "Qualitative." Inclusion criteria were as follows: English language, empirical studies, adult carers, and articles published between 2011 and 2021. Data were abstracted, and study quality was assessed using the Critical Appraisal Skills Programme checklist for qualitative research. RESULTS Fourteen relevant articles were included. Three overarching themes reflecting the factors influencing family preparedness for their role were identified: "motivations for providing care," "interactions with health-care professionals," and "changes during the caring process." SIGNIFICANCE OF RESULTS Inadequate preparation of family carers is apparent with regard to their role in providing end-of-life care at home for patients with advanced cancer. There is a need for health-care workers to more effectively identify the information and support needs of families, and utilize evidence-based strategies that have emerged to address these needs.
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Affiliation(s)
- Emily Ongko
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Philip
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Department of Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Nienke Zomerdijk
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia
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Gérain P, Wawrziczny E, Antoine P. A scoping review of intensive longitudinal methods in informal caregivers of people with dementia. BMC Geriatr 2023; 23:456. [PMID: 37488491 PMCID: PMC10367249 DOI: 10.1186/s12877-023-04123-6] [Citation(s) in RCA: 1] [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: 01/02/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The daily life of informal caregivers assisting individuals with dementia widely varies throughout the day and week. As an answer, an increasing number of researchers have used intensive longitudinal methods (ILMs) such as diary studies, experience sampling methods, or ecological momentary assessment. OBJECTIVES AND METHODS The present scoping review aims at synthesizing the use of ILMs in informal dementia caregivers to clarify what is currently done and how, as well as what remains unaddressed. RESULTS The screening process identified 48 studies from 22 different datasets. Synthesis of these studies showed the diversity of devices and uses of ILMs in informal care, including the exploration of associations between variables or accompanying an intervention. ILMs showed the important variability of caregiving phenomena, as well as the important association of momentary stress and well-being. Gaps were nevertheless identified, such as transparency in the construction of the tool or the absence of focus on emotions and dyads. CONCLUSIONS For now, this field of research remains in its infancy and does not seem to have reached its full potential as it has in other fields. Nevertheless, it appears that ILMs are promising tools for informal dementia caregivers as they contribute to understanding the complexity of their daily life, with changing resources and challenges. Future directions include focusing more on (emotion) regulation, temporal lags, and the use of ILMs in interventional designs. TRIAL REGISTRATION The present review was registered on OSF (osf.io/b2qr4).
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Affiliation(s)
- P Gérain
- Department of Psychology, Faculty of Educational and Psychological Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
- SCALAB - UMR 9193, University of Lille, Lille, France.
| | - E Wawrziczny
- SCALAB - UMR 9193, University of Lille, Lille, France
| | - P Antoine
- SCALAB - UMR 9193, University of Lille, Lille, France
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11
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Lessing S, Deck R, Berwig M. Telephone-based aftercare groups for family carers of people with dementia - results of a mixed-methods process evaluation of a randomized controlled trial. BMC Health Serv Res 2023; 23:643. [PMID: 37322489 DOI: 10.1186/s12913-023-09579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/18/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Caring for a relative with dementia can be demanding and time-consuming. It is not uncommon for them to be overburdened and overworked, which can lead to symptoms of depression or anxiety disorders in 2/3 of cases. One possibility for treating family carers who have these issues is special medical rehabilitation (rehab). However, studies have shown that while such rehab is effective, it is not sustainable. To increase the sustainability of rehab for this target group, structured telephone-based aftercare groups were implemented in the present study. A process evaluation was conducted focusing on the acceptability of the aftercare programme and its perceived benefits by the participating family carers and group moderators. METHODS The process evaluation was embedded in a longitudinal randomized controlled trial and followed a mixed methods approach. Quantitative process data were collected using protocols and structured brief evaluations regarding the telephone-based aftercare groups. To assess the acceptability of the aftercare groups as well as their subjective evaluation by the participants, qualitative process data were collected through two longitudinal telephone-based interviews with a subsample of family carers as well as a focus group interview with the group moderators. RESULTS Telephone-based aftercare groups provide acceptable and supportive experiences, and they are shown to be practicable. The content structure and the procedure of the group sessions could be easily implemented in everyday life after inpatient rehab. The topics addressed with each patient were met with a consistently positive response. Learning from the other group members and sharing a bond based on the experience of caring for a relative with dementia were evaluated as positive outcomes in the group. The universality of suffering as a central effective factor of group psychotherapy also played a decisive role in this telephone-based support group format for a shared bonding and strengthening experience in the groups and thus for their effectiveness. CONCLUSION Telephone-based aftercare groups for family carers of people with dementia are a useful and acceptable tool in the context of rehab aftercare. This location-independent aftercare programme could be adapted for other indications, focuses or topics in everyday care. TRIAL REGISTRATION German Clinical Trials Register: DRKS00013736, 14/05/2018.
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Affiliation(s)
- Susanne Lessing
- Clinic for Cognitive Neurology, Medical Faculty, University of Leipzig, Liebigstr. 16, 04103, Leipzig, Germany
| | - Ruth Deck
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 , Lübeck, Germany
| | - Martin Berwig
- Clinic for Cognitive Neurology, Medical Faculty, University of Leipzig, Liebigstr. 16, 04103, Leipzig, Germany.
- Institute for General Practice, Medical Faculty, Otto-Von-Guericke-University of Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany.
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Straße 12, 58453, Witten, Germany.
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
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12
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O'Hara L, Evans CJ, Bowers B. Family carers' administration of injectable medications at the end of life: a service evaluation of a novel intervention. Br J Community Nurs 2023; 28:284-292. [PMID: 37261983 DOI: 10.12968/bjcn.2023.28.6.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Timely and safe administration of injectable medications for patients at home is vital in optimally managing distressing symptoms in the final days of life. This article discusses a service evaluation of family carers' (including close friends) administrating subcutaneous end-of-life medications. The procedure was not intended to become normal care, rather the exception when appropriate and needed, with 24/7 skilled support from community nursing and palliative care services. A service evaluation of the procedure was undertaken in rural and urban areas in the South East of England. The procedure ran over 6 months and used detailed processes with recruitment criteria to mitigate risk of harm. In total, 11 patients participated with their family carers, including five carers with experience in healthcare roles. Of the 11 family carers, 10 were able to administer injections safely with structured training and support in place. Patients received timely symptom relief and their family carers were able to support loved ones by administering injectable medications rapidly without waiting for a nurse to arrive. This was particularly welcomed in more rural areas where waiting times were greater due to the large geographical area covered and limited staff availability during out-of-hours periods. The findings informed a carefully monitored wider rollout and ongoing evaluation in adult community nursing services in the NHS Trust.
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Affiliation(s)
- Lisa O'Hara
- Nurse Consultant, Palliative and End of Life Care (PEoLC), Sussex Community NHS Foundation Trust
| | - Catherine J Evans
- Professor of Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London; Honorary Nurse Consultant, Sussex Community NHS Foundation Trust
| | - Ben Bowers
- Wellcome Post-Doctoral Research Fellow, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge; Community Nursing Research Consultant, Queen's Nursing Institute, London; Honorary Nurse Consultant in Palliative Care, Cambridgeshire and Peterborough NHS Foundation Trust
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13
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Kaniamattam M, Oxley J. Qualitative analysis of social support for caregivers of children with neurodevelopmental disorders in South India. Res Dev Disabil 2023; 138:104539. [PMID: 37224595 DOI: 10.1016/j.ridd.2023.104539] [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] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Despite its importance, limited formal social supports are available for caregivers of children with neurodevelopmental disorders (NDDs) navigating rehabilitation and caregiving in low-resource contexts. The current study investigates the social support sources and coping processes of caregivers of children with NDD at a rural rehabilitation center in South India. An emphasis is placed on interactions between the study participants and families of other children with NDD receiving services at the center. METHODS AND PROCEDURE A constructivist grounded theory methodology was adopted. Data analysis was based on data obtained from twenty-two parents obtaining rehabilitation services in the center over two phases. OUTCOMES AND RESULTS Constant comparative analysis of caregivers' perceptions and experiences generated a theoretical framework of the long-term emergence of social support and coping, comprising three subcategories: accessing service, gaining acceptance and experiencing support at a grassroots level, and coping at a grassroots level. CONCLUSIONS AND IMPLICATIONS Findings illustrate the need for and benefit of supporting caregivers of children with NDD to find informal social support. Critical considerations for rehabilitation providers, researchers, and policymakers to facilitate caregivers' formal and informal social support and coping skills are discussed.
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Affiliation(s)
- Monica Kaniamattam
- School of Rehabilitation Sciences, Moravian University, Bethlehem, PA, USA.
| | - Judith Oxley
- Department of Communicative Disorders, University of Louisiana at Lafayette, Lafayette, LA, USA
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14
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Giunta S, Butow P, Juraskova I, Sharpe L, Ferguson E, Laidsaar-Powell R. Empowering family carers of people with multimorbidity as partners in chronic health care: Insights from health professionals. Patient Educ Couns 2022; 105:3550-3557. [PMID: 36096983 DOI: 10.1016/j.pec.2022.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES People living with multimorbidity often rely on the support of informal family carers, yet challenges frequently arise when carers of people with multimorbidity (PwM) interact with health professionals (HPs) and healthcare systems. This study aimed to provide insights into the experiences and challenges involved in working with carers of PwM, from HPs' perspectives. METHODS Twenty-one HPs (11 doctors, 5 nurses and 5 allied health professionals) from varying specialities participated in semi-structured interviews. Interviews were transcribed and qualitatively analysed using thematic analysis. RESULTS Five themes were identified: carer involvement makes multimorbidity easier to manage, differing views on HP's responsibilities to carers, multimorbidity makes management harder for HPs, strategies to support carers of PwM, and multimorbidity is one aspect of complexity. CONCLUSIONS HPs recognise unique needs of carers of PwM, yet perceive challenges addressing these needs and supporting this commonly overlooked group. PRACTICE IMPLICATIONS The unmet needs of carers of PwM that HPs identified in this study suggest pathways for future improvements and interventions, including HP education and training, and appropriate referral pathways for carers of PwM to access supportive services. Underpinning these findings is the need for greater recognition and respect for the critical work of family carers in healthcare.
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Affiliation(s)
- Sarah Giunta
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia
| | - Phyllis Butow
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; The University of Sydney, Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, Sydney, Australia
| | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; The University of Sydney, Centre for Medical Psychology & evidence-based Decision-making (CeMPED), School of Psychology, Faculty of Science, Sydney, Australia; The University of Sydney, Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, Sydney, Australia
| | - Louise Sharpe
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia
| | - Eliza Ferguson
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia
| | - Rebekah Laidsaar-Powell
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; The University of Sydney, Centre for Medical Psychology & evidence-based Decision-making (CeMPED), School of Psychology, Faculty of Science, Sydney, Australia; The University of Sydney, Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, Sydney, Australia.
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15
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Isabel V, Joachim C, Peter H, Chantal VA, Luc D, Aline DV. Support from healthcare professionals in empowering family carers to discuss advance care planning: A population-based survey. Palliat Med 2022; 37:719-729. [PMID: 36349646 DOI: 10.1177/02692163221135032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Family carers have a prominent role in end-of-life care for seriously ill persons. However, most of the Advance Care Planning literature is focused on the role of healthcare professionals. AIMS To investigate (1) what proportion of family carers discussed advance care planning with their relative and associated socio-demographic and clinical characteristics (2) what proportion received support from healthcare professionals for these conversations, (3) what type of support they received and (4) to what extent the type of support received was considered sufficient. DESIGN/PARTICIPANTS Population-based cross-sectional survey in Belgium of bereaved family carers of persons with a serious chronic illness (N = 3000) who died 2-6 months before the sample was drawn, identified through three sickness funds. The survey explored support from healthcare professionals for family carers during the last 3 months of the patient's life. RESULTS Response rate was 55%. The proportion of family carers that engaged in an advance care planning conversation with their relative was 46.9%. Of these family carers, 78.1% received support from a healthcare professional, mostly by doing the advance care planning conversation together (53.8%). Of family carers receiving support from a healthcare professional, 57.4% deemed the support sufficient. CONCLUSION Many family carers engage in advance care planning conversations with their dying relative. Healthcare professionals often support them by performing the advance care planning conversations together. More insight into how family carers can be supported to conduct these advance care planning conversations, both with and without involvement of healthcare professionals, is necessary.
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Affiliation(s)
- Vandenbogaerde Isabel
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Cohen Joachim
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Hudson Peter
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Centre for Palliative Care, St Vincents Hospital, The University of Melbourne, Melbourne, Australia
| | | | - Deliens Luc
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - De Vleminck Aline
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
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16
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Lawson S, Mullan J, Wong G, Zaman H, Booth A, Watson A, Maidment I. Family carers' experiences of managing older relative's medications: Insights from the MEMORABLE study. Patient Educ Couns 2022; 105:2573-2580. [PMID: 35016779 DOI: 10.1016/j.pec.2021.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 10/18/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the burdens experienced by family carers who support older relatives to manage their medications at home. METHODS This study, based on a larger UK medication management study: MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation (MEMORABLE), reports on findings from family carer interviews (n = 16). The five stages of medication management, identified in MEMORABLE, were used to inform the analysis. RESULTS Family carers described being involved in some or all five of the MEMORABLE stages to help manage older relatives' medications. Their capacity to undertake this role was sometimes limited by the complex workload involved as well personal circumstances such as time, distance and relationships. Family carers perceived that their knowledge and skills in medication management improved with experience, but also described stress associated with information lag and gaps, risk and responsibility, and loss. They described medication management burdens that needed mitigation: ambiguity, concealment, unfamiliarity, fragmentation and in particular exclusion, conflicted interests and expectation of coping. CONCLUSION To help mitigate these burdens, family carers should receive better information, training and support for this role. PRACTICE IMPLICATIONS Continued reliance on family carers for medication management requires strategic recognition in policy, funding and practice.
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Affiliation(s)
- Sally Lawson
- School of Life and Health Sciences, Aston University, Birmingham B4 7ET, UK.
| | - Judy Mullan
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - Hadar Zaman
- School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Richmond Road, Bradford BD7 1DP, UK.
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK.
| | - Anne Watson
- Bournville & Northfield PCN, Our Health Partnership, UK.
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham B4 7ET, UK.
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17
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Camões-Costa V, Loganathan J, Barton C, Chakraborty S, Hewitt A, Lin X, Brijnath B. Factors contributing to the mental health outcomes of carers during the transition of their family member to residential aged care: a systematic search and narrative review. BMC Geriatr 2022; 22:433. [PMID: 35581539 PMCID: PMC9115935 DOI: 10.1186/s12877-022-03105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The transition of an older family member into a residential aged care facility (RACF) is often challenging for both the person being admitted and their family carer. This review aimed to identify the protective and contributing factors to adverse mental health outcomes among family carers following the decision to move a family member to a RACF. METHOD A search of CINAHL, PubMed and PsycINFO was conducted for empirical papers published in English between 2004 and 2019, exploring the mental health or quality of life (QoL) of family carers of those recently admitted, or considering admission, to a RACF. Articles were reviewed by two authors for inclusion. RESULTS Twenty-three studies met the inclusion criteria. Pre-existing depressive symptoms and poor subjective health were related to adverse mental health outcomes following admission. Information from the facility, support to change roles, and factors related to carer's health and demographics, were associated with changes in the mental health outcomes of carers during the transition of their relative to a RACF. Key protective factors of carer's mental health outcomes following the transition of their relative to a RACF are flow and transparency of information between carer and the facility staff, and staff efforts to involve carers in providing emotional support to their relative, in monitoring care, and advocating for their quality of life. CONCLUSION There is evidence to suggest factors such lack of flow and transparency of information between carer and the facility staff may predispose carers to poor mental health and QoL following the transition of a relative to a RACF. Key protective factors of carer's mental health following admission are staff efforts to involve carers in providing emotional support to their relative, in monitoring care, and advocating for their quality of life. This review also indicates that the combination of factors that puts family carers more at risk of poor mental health and lower quality of life throughout the transition period. Policy and practice should follow recommendations that consider a combination of the above factors when addressing the needs of family carers before and after admission of an older person to RACF.
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Affiliation(s)
- Vera Camões-Costa
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
| | - Jayasree Loganathan
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Chris Barton
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Samantha Chakraborty
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Alana Hewitt
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Xiaoping Lin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bianca Brijnath
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
- National Ageing Research Institute Ltd, Parkville, Australia
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
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18
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Gerritsen DL, Leontjevas R, Prins M, van der Roest H. [Consequences of the COVID-19 measures for wellbeing aspects of long-term care residents]. Tijdschr Gerontol Geriatr 2022; 53. [PMID: 36408649 DOI: 10.36613/tgg.1875-6832/2022.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
To examine the impact of COVID-19 measures on residents of long-term care institutions, two surveys were conducted in the spring of 2020. Leontjevas et al. (study 1) inventoried practitioners' opinions, Van der Roest et al. (study 2) opinions of care workers, family, and residents without severe cognitive impairments. This article describes the combined results on social interaction and loneliness, challenging behaviour and mood, and lessons learned. In study 1, an online survey distributed to nursing home psychologists, they were asked to complete it anonymously and share the link with their fellow elderly care physicians and nurse specialists. 16 participants were then interviewed via video calling. In study 2, three hundred and fifty-seven care organizations were invited to recruit residents without severe cognitive impairments, family members and care workers for participating in a digital, anonymous survey (Study 2). The completed surveys of 323 practitioners (study 1) and 193 residents, 1609 family members and 811 employees (study 2) were included in the analyses. Social contacts of residents had changed in frequency and form compared to before the COVID-measures. Many residents experienced some loneliness during the visit ban, especially residents without cognitive impairments. There were both an increase and a decrease in challenging behaviour and affect. Several strategies used to reduce the effects of COVID-19 measures on well-being, were considered maintainable. Our studies confirmed a major impact of the COVID-19 measures on the wellbeing of long-term care residents, but also showed successful strategies of practitioners that can benefit future practice.
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19
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Wolverson E, Moniz-Cook E, Dunn R, Dunning R. Family carer perspectives on the language of behaviour change in dementia: an online mixed methods survey. Age Ageing 2022; 51:6540141. [PMID: 35231095 DOI: 10.1093/ageing/afac047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE following the #BanBPSD campaign there has been critical interest in common terminology used for 'changes in behaviour' associated with dementia. However, commentaries and emerging studies have not fully considered family carer perspectives. This study explores the views of family carers on terminology and language for this paradigm. METHOD a mixed methods online survey was conducted with family carers. Language preferences were scoped and examined with supporting open-ended questions that explored the reasons for choices. RESULTS about 229 family carers completed the survey. Terms such as Challenging Behaviour, Behaviour that Challenges and Behavioural and Psychological Symptoms of dementia were mostly disliked. The most preferred term was a new concept called 'Behavioural and Emotional Expressions of Need' that few people had previously heard of. Overall, carers preferred positively construed, easily understood, person-centred terms that attributed changes in behaviour to unmet need, which also acknowledged the carer's role in management. CONCLUSIONS given that carers are often the agents of change for this paradigm-where they may also be called on to act as proxy decision makers, it is important that professionals take time to explore their understandings and give due consideration to the language used when offering tailored interventions. These findings suggest that frequently used terms for changes in behaviour associated with dementia, such as Challenging Behaviour, BtC and BPSD, should be avoided.
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Affiliation(s)
- Emma Wolverson
- Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK
- Humber Teaching NHS Foundation Trust, UK
| | - Esme Moniz-Cook
- Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK
| | - Rosie Dunn
- Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK
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20
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Loi SM, Tropea J, Gaffy E, Panayiotou A, Capon H, Chiang J, Bryant C, Doyle C, Kelly M, Livingston G, Dow B. START-online: acceptability and feasibility of an online intervention for carers of people living with dementia. Pilot Feasibility Stud 2022; 8:41. [PMID: 35172894 PMCID: PMC8848667 DOI: 10.1186/s40814-022-00999-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/02/2022] [Indexed: 01/25/2023] Open
Abstract
Background With increasing numbers of people living with dementia relying on family to care for them at home, there is an urgent need for practical and evidence-based programs to support carers in maintaining their mental health and well-being. The objective of this study was to evaluate the acceptability and feasibility of a modified STrAtegies for RelaTives (START) program delivered online (START-online). Method A mixed-methods non-blinded evaluation of START-online (using Zoom as videoconferencing platform) for acceptability and feasibility (completion rates and qualitative feedback through surveys and focus groups) and quantitative evaluation. This occurred at the National Ageing Research Institute, in metropolitan Victoria, Australia. Results Twenty-nine eligible carers were referred, 20 (70%) consented to the study. Of these, 16 (80%) completed all 8 sessions, 2 completed only 3 sessions, and 2 withdrew. Carers’ qualitative feedback indicated that the therapist interaction was valued, content and online delivery of the program was acceptable. Feedback was mixed on the appropriate stage of caring. Conclusion START-online was feasible and acceptable for carers, including those living outside of metropolitan areas who might otherwise be unable to access face-to-face programs. With the recent COVID-19 pandemic necessitating social distancing to avoid infection, interventions such as this one have increasing relevance in the provision of flexible services. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00999-0.
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Affiliation(s)
- Samantha M Loi
- Neuropsychiatry, North Western Mental Health, Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia. .,Melbourne Neuropsychiatry Centre, Department of Psychiatry, the University of Melbourne and Royal Melbourne Hospital, Grattan Street, Parkville, 3050, Australia.
| | - Joanne Tropea
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, 3050, Australia
| | - Ellen Gaffy
- National Ageing Research Institute, Poplar Road, Parkville, 3050, Australia
| | - Anita Panayiotou
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, the University of Melbourne and Royal Melbourne Hospital, Grattan Street, Parkville, 3050, Australia.,Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia.,Safer Care Victoria, Melbourne, 3000, Australia
| | - Hannah Capon
- National Ageing Research Institute, Poplar Road, Parkville, 3050, Australia
| | - Jodi Chiang
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Melbourne, 3010, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Melbourne, 3010, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Poplar Road, Parkville, 3050, Australia
| | - Michelle Kelly
- School of Psychology, University of Newcastle, Newcastle, 2308, Australia
| | - Gill Livingston
- UCL Division of Psychiatry 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Briony Dow
- National Ageing Research Institute, Poplar Road, Parkville, 3050, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Nursing and Midwifery, Deakin University, Geelong, Australia
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21
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Chiu MYL, Leung CLK, Li BKK, Yeung D, Lo TW. Family caregiving during the COVID-19 pandemic: factors associated with anxiety and depression of carers for community-dwelling older adults in Hong Kong. BMC Geriatr 2022; 22:125. [PMID: 35164704 PMCID: PMC8845211 DOI: 10.1186/s12877-021-02741-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 pandemic disrupts the daily routine and increases the caregiving load of the family carers of older adults. This study examined how the pandemic may impact mental health and investigated the prevalence of anxiety and depressive symptoms in family carers of older people. Methods Two hundred and thirty-six family carers of older adults participated in this cross-sectional survey study. Outcome measures included their symptoms of anxiety and depression, pandemic-related psychosocial factors, external factors, and the practice of preventive behaviours. Results Caseness prevalence of anxiety and depression among family carers was 25 and 56% respectively. Working carers were more depressed than non-working, while younger carers reported more anxiety and depression symptoms than older. Hand hygiene and getting drugs from the hospital positively predicted depression while healthy lifestyle negatively predicted depression. These variables, together with perceived risk and severity and the worry of getting infected, predicted anxiety. Conclusions The prevalence of mental health symptoms was alarming. Telemedicine practice, including online pharmaceutical services and the Internet Hospital plus Drug Delivery platform, could be a solution in alleviating the burden and worry of infection of family carers. Tailored-made interventions by age and working status of the family carers are recommended.
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Affiliation(s)
- Marcus Y L Chiu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong. .,University of Bolton, England, UK.
| | - Cyrus L K Leung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong.,JC School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Ben K K Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Dannii Yeung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - T W Lo
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
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22
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Bartels SL, van Knippenberg RJM, Viechtbauer W, Simons CJP, Ponds RW, Myin-Germeys I, Verhey FRJ, de Vugt ME. Intervention mechanisms of an experience sampling intervention for spousal carers of people with dementia: a secondary analysis using momentary data. Aging Ment Health 2022; 26:294-304. [PMID: 33291998 DOI: 10.1080/13607863.2020.1857692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: A psychosocial intervention for spousal carers of people with dementia promoted emotional well-being through self-monitoring and personalized feedback, as demonstrated in a previous randomized controlled trial. The mechanism behind the intervention effects is thought to lie in increased awareness of, and thus, engagement in behaviours that elicit positive emotions (PA). This secondary analysis tests the assumption by investigating momentary data on activities, affect, and stress and explores the relevance of personalized feedback compared to self-monitoring only.Methods: The intervention was based on the experience sampling method (ESM), meaning that carers self-monitored own affect and behaviours 10 times/day over 6 weeks. The experimental group received personalized feedback on behaviours that elicit PA, while the pseudo-experimental group performed self-monitoring only. A control group was also included. ESM-data of 72 carers was analysed using multilevel mixed-effects models.Results: The experimental group reported significant increases in passive relaxation activities over the 6 weeks (B = 0.28, SE = 0.12, Z = 2.43, p < .05). Passive relaxation in this group was negatively associated with negative affect (r = -0.50, p = .01) and positively associated with activity-related stress (r = 0.52, p = .007) from baseline to post-intervention. Other activities in this or the other groups did not change significantly.Conclusion: Carer's daily behaviours were only affected when self-monitoring was combined with personalized feedback. Changing one's daily behaviour while caring for a person with dementia is challenging and aligned with mixed emotions. Acknowledging simultaneously positive and negative emotions, and feelings of stress is suggested to embrace the complexity of carer's life and provide sustainable support.
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Affiliation(s)
- Sara Laureen Bartels
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Rosalia J M van Knippenberg
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands.,GGzE, Institute of Mental Health Care Eindhoven, Eindhoven, The Netherlands
| | - Rudolf W Ponds
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Frans R J Verhey
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Marjolein E de Vugt
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
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23
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Garfield S, Begum A, Toh KL, Lawrence-Jones A, Staley K, Franklin BD. Do patients and family carers have different concerns about the use of medicines compared with healthcare professionals? A quantitative secondary analysis of healthcare concerns relating to adults with complex needs. Patient Educ Couns 2022; 105:447-451. [PMID: 34034937 DOI: 10.1016/j.pec.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To identify concerns related to the use of medicines for adults with complex needs and explore whether these differed between healthcare professionals and patients/carers, in order to inform development of interventions to increase medication adherence. METHODS A quantitative secondary analysis of a database of healthcare professionals' and patients'/carers' healthcare concerns, related to adults with complex needs. Categories of concerns related to medicines use were identified and concerns related to medication use coded against these. Data were analysed descriptively, and a Chi-square test conducted to test for differences in responses from healthcare professionals versus patients/carers. RESULTS There was a significant difference in the types of medication concern raised by healthcare professionals versus those raised by patients/carers. Patients/carers expressed more concerns about side effects and interactions; healthcare professionals identified more concerns related to patient support and carers' knowledge/training. CONCLUSION Healthcare professionals had significantly different concerns about medicines to patients; this may be a potential barrier to medication adherence. PRACTICE IMPLICATIONS Healthcare professionals may need to adopt an approach to non-adherence that goes beyond education and counselling and adopts a wider patient perspective. Findings suggest that a greater focus on addressing side effects and interactions may be beneficial in increasing medication adherence.
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Affiliation(s)
- Sara Garfield
- Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Patient Safety Translational Research Centre, London, UK; UCL School of Pharmacy, London, UK.
| | | | | | | | | | - Bryony D Franklin
- Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Patient Safety Translational Research Centre, London, UK; UCL School of Pharmacy, London, UK
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24
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Vseteckova J, Jordan J, Tilley E, Larkin M, Ryan S, Wallace LM. Transitions for older people with learning disabilities and behaviours that challenge others, and their family carers: a merged protocol for two rapid scoping reviews of evidence. Syst Rev 2022; 11:14. [PMID: 35042546 PMCID: PMC8767693 DOI: 10.1186/s13643-021-01883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There are over 1 million adults with a learning disability in the UK, of whom approximately 20% displaying behaviours that challenge others. Two thirds of people with learning disabilities live in the family home. As they and their family carers age, both are likely to face particular difficulties and stresses, but there is little understanding of their experiences and needs. To address this evidence gap, our main objective is to undertake two rapid scoping reviews that will collectively focus on the health and social care needs, experiences, service interventions and resources of older people with learning disabilities and behaviours that challenge others, and their family carers. Both reviews will focus on issues relating to forward planning and transitions to different care contexts. The study is part of a research project funded by the National Institute for Health Research No.129491. METHODS We propose to address the need for evidence via two rapid scoping reviews. We will include published and unpublished (grey) literature, encompassing empirical research, policy and practice guidance and lay resources to support decision-making. We will search multiple electronic databases, hand search references lists, and use expert guidance to identify potential evidence. The following databases were used for research and grey literature: CINAHL; Healthcare Management Information Consortium (HMIC); NHS Evidence; Scopus; Turning Evidence Into Practice (TRIP); Web of Science (WoS); Google (first 5 pages); and Google Scholar (first 5 pages). For RR2, additional intended databases are the Carer Research Knowledge Exchange Network (CAREN) and Social Care Institute for Excellence (SCIE). Two reviewers will independently screen all citations and full-text articles for inclusion. One reviewer will extract data, with an independent review undertaken by the research team. Critical appraisal will depend on the nature of included evidence. Narrative synthesis will be collaboratively developed, with descriptive information presented in tables summarising study characteristics and thematic analysis of findings presented in the main text. Dissemination will be through journal publication, conference presentations and written short-form, easy-read versions of articles and audio-video clips for lay audiences. DISCUSSION We will consider the strengths and limitations of our reviews, considering their impact on findings. We will summarise the main findings and provide an interpretation linked to the review questions and objectives. We will consider the implications of our findings for policy and practice, as well as future research addressing the support of older people with learning difficulties and behaviours that challenge others, and their family carers, in the context of transition to different care contexts in the UK. The protocol has been registered as Vseteckova, J., Jordan, J., Tilley, E., Larkin, M., Ryan, S., and Wallace, L. (2021, December 4). Transitions for older people with learning disabilities and behaviours that challenge others, and their family carers: a merged protocol for two rapid scoping reviews of evidence. Retrieved from osf.io/jzrn9.
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Affiliation(s)
- J. Vseteckova
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - J. Jordan
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - E. Tilley
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - M. Larkin
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - S. Ryan
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - L. M. Wallace
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
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25
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Aker N, West E, Davies N, Moore KJ, Sampson EL, Nair P, Kupeli N. Challenges faced during the COVID-19 pandemic by family carers of people living with dementia towards the end of life. BMC Health Serv Res 2021; 21:996. [PMID: 34548067 PMCID: PMC8454696 DOI: 10.1186/s12913-021-07019-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023] Open
Abstract
Background People living with dementia account for a large proportion of deaths due to COVID-19. Family carers are faced with making significant and emotive decisions during the pandemic, including decisions about end of life. We aimed to explore the challenges faced by family carers of people living with dementia during the first wave of the COVID-19 pandemic in England, as reported by charity telephone support line staff, who were able to objectively discuss a range of different experiences of many different carers who call the helpline. In particular, we focussed on key concerns and areas of decision making at the end of life. Methods We conducted a qualitative study using semi-structured interviews with eight telephone support line staff from two UK based charities who support carers of people living with dementia and those at the end of life. Interviews were conducted in the first wave of the pandemic in England in May–June 2020. Results An overarching theme of uncertainty and reactivity during a crisis was identified, and within this, five main themes were identified: concerns about care transitions, uncertainty in engaging support and help, pandemic-motivated care planning, maintaining the wellbeing of the person living with dementia, and trust, loss of agency and confusion. Conclusions Family carers may be reluctant to seek support because of fear of what may happen to their relative, which may include hospitalisation and becoming ill with COVID-19, care home placement, or not being able to be with a relative at the end of life. In some cases, a lack of trust has developed, and instead carers are seeking support from alternative services they trust such as nationally known charities.This study was used to inform the development of a decision aid to support family carers making decisions about care for their relative with dementia during the pandemic, who the lack the capacity to make their own decisions.
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Affiliation(s)
- Narin Aker
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Emily West
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,National Ageing Research Institute, Parkville, Victoria, Australia
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet, Enfield and Haringey Mental Health Liaison Service, North Middlesex University Hospital NHS Trust, London, UK
| | - Pushpa Nair
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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26
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Teahan Á, Walsh S, Doherty E, O'Shea E. Supporting family carers of people with dementia: A discrete choice experiment of public preferences. Soc Sci Med 2021; 287:114359. [PMID: 34530220 DOI: 10.1016/j.socscimed.2021.114359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/29/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Community-based care for people with dementia is mainly provided by family carers, many of whom experience decreased mental, physical and financial well-being due to their caring role. Many countries are now implementing ageing-in-place policies that have increased pressure on family carers as care-work is redistributed from residential to community-based settings. Family caring responsibilities for people with dementia are made even more complicated by the economic, social and cultural expectations that underpin existing provision. Support for family carers is, therefore, an important policy topic across many countries. The focus of this paper is on the propensity of citizens to support enhanced care for family carers in Ireland, as demonstrated by their willingness-to-pay additional taxation to fund different combinations of carer support measures, developed through careful and sustained dialogue with multiple stakeholders, especially family carers themselves. We carried out a discrete choice experiment (DCE) with 509 members of the general public in Ireland between January and February 2021. Using mixed logit models, our findings show that citizens value four key attributes: regular caring breaks for family carers (day-care and long-break respite); financial compensation (carer's allowance); and emotional support (carer peer support groups). We also estimated the welfare impact of moving from current provision to enhanced support packages for family carers of people with dementia. The welfare gains accumulate to €1035.80 for the most complete levels of provision across the four support attributes. Overall, respondents in this paper showed empathy and understanding towards family carers of people with dementia through their willingness to contribute to funding additional services and supports.
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Affiliation(s)
- Áine Teahan
- Centre for Economic and Social Research on Dementia, National University of Ireland, Galway, Ireland.
| | - Sharon Walsh
- School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Edel Doherty
- School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, National University of Ireland, Galway, Ireland.
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27
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Atout M, Alrimawi I, Daibes MA, Abusalameh E. The lived experience of family members who care for children with cancer: An interpretative phenomenological approach. Eur J Oncol Nurs 2021; 52:101978. [PMID: 34090147 DOI: 10.1016/j.ejon.2021.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/19/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to explore the lived experiences of family carers in the care of children with cancer. METHOD A phenomenological hermeneutic approach was conducted, informed by the philosophy of Martin Heidegger. Fourteen interviews were conducted with family members: mothers (n = 9), grandmothers and fathers (n = 5). Fourteen family carers were voluntarily enrolled from a public children's oncology department in Bethlehem in the Occupied Palestinian Territories. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. RESULTS Three major themes emerged from the data analysis. The first theme was the caring experience, which included three subthemes: changing priorities over time, information given about children's illness, and parents suffering due to treating irritable children. The second theme was the challenges to effective care, which illustrates the most significant challenges faced during caring, including the effects of family relations and emotional support. The final theme was around the support system; family carers found several resources to support them in their children's care, including other parents' experiences with similar diseases, the hospital environment, and their religious beliefs. CONCLUSIONS This study informs parents and healthcare providers about the daily lived experiences of family carers. Healthcare providers can fulfil a significant role in giving emotional support and relief to family carers. However, they will need continuous practise to equip them with the communication skills they require to deal with the family carers in these difficult situations.
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Affiliation(s)
- Maha Atout
- Nursing School, Philadelphia University, Office 509, Jarash Road, P.O. Box 19392, Amman, Jordan.
| | - Intima Alrimawi
- School of Nursing and Health Professions, Trinity Washington University, 125 Michigan Ave, NE, Washington, DC, 20017, USA.
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28
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Stasiulis E, Rapoport MJ, Sivajohan B, Naglie G. The Paradox of Dementia and Driving Cessation: "It's a Hot Topic," "Always on the Back Burner". Gerontologist 2021; 60:1261-1272. [PMID: 32301497 DOI: 10.1093/geront/gnaa034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the well-recognized difficulty that persons with dementia and family carers experience in the decision making and transition to nondriving, there are few interventions and resources to support them. As part of our ongoing research to develop a driving cessation toolkit that addresses this gap, we sought to examine the context-specific factors relevant to its effective implementation in settings that support older adults with dementia. RESEARCH DESIGN AND METHODS A qualitative descriptive approach was used to explore the perspectives of Alzheimer Society (AS) staff in their work of supporting people with dementia and family carers within the context of driving cessation. Individual in-depth interviews were conducted with 15 AS staff members in 4 Canadian provinces. Data were examined using interpretative thematic analysis. RESULTS The study results revealed an overarching paradox that despite the importance of driving cessation in people with dementia, it continues to be largely avoided at the individual and system levels. This is explored via the themes of (a) paradox of importance and avoidance identified in AS settings; (b) lack of awareness and understanding about dementia and driving among people with dementia and family carers; (c) distress and avoidance rooted in ongoing system issues; and (d) moving driving cessation to the "front burner." DISCUSSION AND IMPLICATIONS Viewed through the emerging social health paradigm, which focuses on the social and emotional consequences of dementia, our results highlight the urgent need to mobilize our communities, medical education systems, and transportation authorities to finally resolve the dementia and driving cessation paradox.
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Affiliation(s)
- Elaine Stasiulis
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Brintha Sivajohan
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Departments of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
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29
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Ream E, Richardson A, Lucas G, Marcu A, Foster R, Fuller G, Oakley C. Understanding the support needs of family members of people undergoing chemotherapy: A longitudinal qualitative study. Eur J Oncol Nurs 2021; 50:101861. [PMID: 33242701 DOI: 10.1016/j.ejon.2020.101861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Capture change in family members' experiences as they look after patients during chemotherapy, and understand variability in their needs for support. METHOD Longitudinal digitally-recorded qualitative semi-structured interviews with family carers at the beginning, mid-point, and end of treatment. Twenty-five family members (17 women, 8 men), mean age 53, were interviewed. Fifteen participants were supporting a relative having chemotherapy with curative intent, and 10 a patient receiving palliative chemotherapy. They were recruited from two UK locations: a regional cancer centre in Southampton and a comprehensive cancer centre in London. Sixty-three interviews were conducted in total, and the data were analysed using Framework Analysis. RESULTS Three themes were generated from the data: Changing lives, Changing roles; Confidence in caring, and Managing uncertainty. These captured family carers' evolving needs and sense of confidence in caregiving during chemotherapy. Carers reported considerable anxiety at the outset of treatment which persisted throughout. Anxiety was underpinned by fears of disease recurrence or progression and concerns about treatment outcomes. CONCLUSIONS This study presents original fine-grained work that captures the changes over time in family carers' experiences of chemotherapy and their adaptation to caregiving. It provides fundamental evidence of the challenges that cancer carers face during patients' treatment; evidence that can be used as a basis for carer assessment and to build much-needed carer interventions. Oncology nurses should assess carers': ability to care; needs for information and support to prepare them for this; wellbeing over time; and, any support they may require to prevent them from becoming overburdened.
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30
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Abstract
Background: The Alzheimer Café is a psychosocial intervention shown to have benefits for family carers of people with dementia. Family carers experience a period of change across all aspects of their lives following the dementia diagnosis, and require new skills and tools to navigate these new landscapes. The objective of this research was to investigate family carers' perspectives of the Alzheimer Café in Ireland, and explore how attendance may translate into broader benefits in their lives. This paper also provides an overview of Alzheimer Café models, which exist internationally. Methods: Semi-structured interviews were conducted with nine family carers of people with dementia who were currently attending or had attended an Alzheimer Café in the preceding six months. The research was conducted in three Alzheimer Cafés in Ireland. Data analysis was conducted using Braun and Clarke's six step thematic analysis framework. Results: Community, atmosphere, activity and information were described as core features of the Alzheimer Café in Ireland. The Alzheimer Café was described as a community with a good atmosphere encompassing emotional support, friendship, equality and inclusion. Family carer also highlighted Alzheimer Cafés could potentially facilitate wider community awareness and engagement. The Alzheimer Café was shown to provide an activity which facilitated relationship building within care dyads as well as with other attendees. Several information streams were identified, including guest speaker input, attendees' shared experiences, and specific advice from healthcare professionals. Conclusion: The Alzheimer Café offers strong personal support to family carers of people with dementia. Our findings suggest that Alzheimer Cafés can build family carers' capacity to manage new social, environmental and cultural challenges associated with dementia. While it is important the Alzheimer Café is enjoyable, has useful information and is supportive, it is equally important that these features generate sustained improvements for family carers external to the Alzheimer Café.
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Affiliation(s)
- Áine Teahan
- Centre for Economic and Social Research on Dementia, NUI Galway, Galway, Ireland
| | - Christine Fitzgerald
- Centre for Economic and Social Research on Dementia, NUI Galway, Galway, Ireland
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, NUI Galway, Galway, Ireland
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31
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Cross AJ, Etherton-Beer CD, Clifford RM, Potter K, Page AT. Exploring stakeholder roles in medication management for people living with dementia. Res Social Adm Pharm 2020; 17:707-714. [PMID: 33722353 DOI: 10.1016/j.sapharm.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Therapeutic decision making, prescribing, administering and managing medications can be difficult for people with dementia. OBJECTIVES To explore stakeholder roles in medication management for people with dementia, including barriers and enablers to achieving those roles. METHODS Focus groups were held with stakeholders (consumers, general practitioners, nurses and pharmacists) from both rural and metropolitan communities in two Australian states. Focus groups were audio-recorded, transcribed and thematically analysed using an inductive approach. RESULTS Nine focus groups were held with 55 participants. Four major themes were identified: supporting the role of the person with dementia, carer roles and challenges, health professional roles, and process and structure barriers to medication management. Stakeholders discussed the importance of advance care planning, and the potential benefits of early implementation of dose administration aids to support patients in self-managing their medication. Carers were seen to have a vital role as patient advocates, but carer burden and changes in the patient-carer roles acted as barriers to this role. General practitioners were perceived as the main care coordinator for a person with dementia, with effective interprofessional collaboration and communication with allied health professionals and specialists further enabling optimisation of medication use. A lack of evidence, guidelines and practitioner training to guide prescribing and deprescribing decisions in people with dementia were mentioned as barriers to medication management. CONCLUSION Medication management is increasingly challenging for people with dementia and each stakeholder perceives that they have a different role and faces different barriers and enablers. Future research should focus on improving the evidence base to guide prescribing, facilitating stakeholder communication and ensuring early documentation of patient wishes for the future.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
| | - Christopher D Etherton-Beer
- Western Australian Centre for Health and Ageing, School of Medicine, University of Western Australia, Perth, Australia
| | - Rhonda M Clifford
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Kathleen Potter
- Western Australian Centre for Health and Ageing, School of Medicine, University of Western Australia, Perth, Australia
| | - Amy T Page
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; School of Allied Health, University of Western Australia, Perth, Australia; Pharmacy Department, Alfred Health, Australia
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32
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Abstract
Background: The Alzheimer Café is a psychosocial intervention shown to have benefits for family carers of people with dementia. Family carers of people with dementia experience a period of change across all aspects of their lives following a diagnosis of dementia, requiring the development of new skills and tools to navigate these new landscapes. The objective of this research is to investigate family carers' perspectives of the Alzheimer Café in Ireland, and to explore how attendance may translate into broader benefits in their lives. This paper will also provide an overview of Alzheimer Café models, which exist internationally. Methods: This is a qualitative study using semi-structured interviews with nine family carers of people with dementia who were currently attending or have previously attended an Alzheimer Café in the preceding six months. The research was conducted in three Alzheimer Café sites in Ireland. Data analysis was conducted using Braun and Clarke's six step framework for thematic analysis. Results: Community, atmosphere, activity and information were described as core features of the Alzheimer Café in Ireland for family carers. The Alzheimer Café was shown to provide a social outlet which facilitated relationship building within care dyads as well as with other attendees. Several information avenues were identified including broad overviews from guest speakers, attendees' shared experiences, and specific advice from healthcare professionals. Conclusion: The Alzheimer Café offers strong personal support to family carers of people with dementia. It can also help to build family carers' capacity to manage new social, environmental and cultural challenges associated with dementia. While it is important the Alzheimer Café is enjoyable, has useful information and is supportive, it is equally important that these features generate sustained improvements for family carers external to the Alzheimer Café.
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Affiliation(s)
- Áine Teahan
- Centre for Economic and Social Research on Dementia, NUI Galway, Galway, Ireland
| | - Christine Fitzgerald
- Centre for Economic and Social Research on Dementia, NUI Galway, Galway, Ireland
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, NUI Galway, Galway, Ireland
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Surr CA, Kelley R, Griffiths AW, Ashley L, Cowdell F, Henry A, Collinson M, Mason E, Farrin AJ. Enabling people with dementia to access and receive cancer treatment and care: The crucial role of supportive networks. J Geriatr Oncol 2020; 11:1125-1131. [PMID: 32253158 PMCID: PMC7544010 DOI: 10.1016/j.jgo.2020.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/27/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Despite cancer and dementia being conditions in which prevalence increases with age, there remains limited research on the cancer treatment and care needs of this population. Our study aimed to address this gap and this paper reports on the role of supportive networks in enabling people with dementia to access cancer treatment and care. MATERIALS AND METHODS An ethnographic study involving seventeen people with cancer and dementia, 22 relatives and nineteen oncology staff. It comprised observations (46 h) of and informal conversations during oncology appointments attended by people with dementia and their relatives and semi-structured interviews (n = 37) with people living with cancer and dementia, their relatives and staff working in various roles across oncology services. Data were analysed using thematic analysis. RESULTS Patients and oncology staff relied on and expected relatives to provide practical and emotional support around cancer treatment and care. Families varied in their ability to provide required support due to extent of the family network, practical issues, knowledge of the patient and their wishes, family conflict and the patient's willingness to accept help. Where no family network was available, support provision was complex and this could compromise access to cancer treatment. CONCLUSIONS People with comorbid cancer and dementia rely heavily on a supportive family network to access treatment and care. Oncology services need to assess the supportive networks available to individual patients in developing cancer treatment plans. Urgent consideration needs to be given to how those with no family networks can be appropriately supported.
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Affiliation(s)
- Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK.
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK.
| | - Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK.
| | - Laura Ashley
- School of Social Sciences, Leeds Beckett University, Leeds, UK.
| | - Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK.
| | - Ann Henry
- Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Medicine, University of Leeds, Leeds, UK.
| | - Michelle Collinson
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Ellen Mason
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Amanda J Farrin
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
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Abstract
BACKGROUND People can live for many months without knowing why their body is failing prematurely before being diagnosed with motor neurone disease (MND); a terminal neurodegenerative disease which can be experienced as 'devastating' for the person and their family. AIM This study aimed to explore the meaning of supporting a loved one with MND to die. METHODS This study uses reflection and autobiographical story to connect with broader cultural, political and social meaning and understandings of dying. FINDINGS Four themes were identified relating to the end-of-life trajectory of MND. Loss of person (lived body experienced in silence); loss of relationships (lived relations are challenged); loss of home and loss of time (lived space and lived time take on new meaning); loss of future (dying-facing it alone). CONCLUSION Dying with MND is a complex phenomenon. When a person can no longer move and communicate, relationships between those involved in end-of-life care are challenging. A person with MND needs the support from those acting as power of attorney to make their end of life their own, and they themselves need support to find meaning in their suffering. This autoethnographic reflection provides vicarious experiences for nurses and other healthcare professionals working with people with MND and similar conditions.
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Affiliation(s)
- Denise Andrea Harris
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester
| | - Kirsten Jack
- Reader in Learning and Teaching Development Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester
| | - Christopher Wibberley
- Principal Lecturer, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester
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Gonella S, Campagna S, Basso I, De Marinis MG, Di Giulio P. Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review. Patient Educ Couns 2019; 102:2134-2144. [PMID: 31278036 DOI: 10.1016/j.pec.2019.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE End-of-life communication has been largely recognized to promote quality end-of-life care in nursing home (NHs) by increasing residents' likelihood of receiving comfort-oriented care. This scoping review summarizes what is known about the potential mechanisms by which end-of-life communication may contribute to palliative-oriented care in NHs. METHODS Using the framework proposed by Arksey and O'Malley and refined by the Joanna Briggs Institute methodology, five literature databases were searched. We extracted 2159 articles, 11 of which met the inclusion criteria: seven quantitative, three qualitative, and one mixed-methods study. RESULTS Three mechanisms were identified: a) promotion of family carers' understanding about their family member's health condition, prognosis, and treatments available; b) fostering of shared decision-making between health care professionals (HCPs) and residents/family carers; and c) using and improving knowledge about residents' preferences. CONCLUSION Family carers' understanding, shared decision-making, and knowledge of residents' preferences contribute to palliative-oriented care in NHs. PRACTICE IMPLICATIONS Discussions about end-of-life should take place early in a resident's disease trajectory to allow time for family carers to understand the condition and participate in subsequent, mindful, shared decision-making. HCPs should conduct systematic and thorough discussions about end-of-life treatment options with all cognitively competent residents to promote informed advance directives.
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Affiliation(s)
- Silvia Gonella
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, Via Montpellier 1, 00133, Roma, Italy; Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126, Torino, Italy.
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126, Torino, Italy
| | - Ines Basso
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126, Torino, Italy
| | - Maria Grazia De Marinis
- Nursing Research Unit, University Campus Bio Medico of Roma, Via Alvaro del Portillo 200, 00128, Roma, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126, Torino, Italy
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Kupeli N, Sampson EL, Leavey G, Harrington J, Davis S, Candy B, King M, Nazareth I, Jones L, Moore K. Context, mechanisms and outcomes in end-of-life care for people with advanced dementia: family carers perspective. BMC Palliat Care 2019; 18:87. [PMID: 31651310 PMCID: PMC6813066 DOI: 10.1186/s12904-019-0467-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/02/2019] [Accepted: 09/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background Keeping people living with advanced dementia in their usual place of residence is becoming a key governmental goal but to achieve this, family carers and health care professionals must negotiate how to provide optimal care. Previously, we reported a realist analysis of the health care professional perspective. Here, we report on family carer perspectives. We aimed to understand the similarities and differences between the two perspectives, gain insights into how the interdependent roles of family carers and HCPs can be optimised, and make recommendations for policy and practice. Method Qualitative study using a realist approach in which we used the criteria from guidance on optimal palliative care in advanced dementia to examine key contexts, mechanisms and outcomes highlighted by family carers. Results The themes and views of family caregivers resonate with those of health care professionals. Their overlapping anxieties related to business-driven care homes, uncertainty of families when making EOL decisions and the importance of symptom management referring to contexts, mechanisms and outcomes, respectively. Contexts specific to family carers were ad hoc information about services, dementia progression and access to funding. Not all family carers identified dementia as terminal, but many recognised the importance of continuity of care and knowing the wishes of the person with dementia. New mechanisms included specific resources for improving EOL care and barriers to discussing and planning for future care. Family carers identified the importance of comfort, being present, the meeting of basic care needs and feeling the right decisions have been made as good outcomes of care. Conclusions Family carers and health care professionals share similar concerns about the challenges to good EOL dementia care. Better understanding of the effects of dementia at the advanced stages would improve confidence in EOL care and reduce uncertainty in decision making for family carers and health care professionals.
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Affiliation(s)
- Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Londonderry, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care & Population Health, University College London, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Richardson A, Blenkinsopp A, Downs M, Lord K. Stakeholder perspectives of care for people living with dementia moving from hospital to care facilities in the community: a systematic review. BMC Geriatr 2019; 19:202. [PMID: 31366373 PMCID: PMC6668086 DOI: 10.1186/s12877-019-1220-1] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 07/22/2019] [Indexed: 11/23/2022] Open
Abstract
Background People living with dementia in care homes are regularly admitted to hospital. The transition between hospitals and care homes is an area of documented poor care leading to adverse outcomes including costly re-hospitalisation. This review aims to understand the experiences and outcomes of care for people living with dementia who undergo this transition from the perspectives of key stakeholders; people living with dementia, their families and health care professionals. Methods A systematic search was conducted on the CINAHL, ASSIA, EMBASE, MEDLINE, PsychINFO, and Scopus databases without any date restrictions. We hand searched reference lists of included papers. Papers were included if they focused on people living with dementia moving from hospital to a short or long term care setting in the community including sub-acute, rehabilitation, skilled nursing facilities or care homes. Titles, abstracts and full texts were screened. Two authors independently evaluated study quality using a checklist. Themes were identified and discussed to reach consensus. Results In total, nine papers reporting eight studies met the inclusion criteria for the systematic review. A total of 257 stakeholders participated; 37 people living with dementia, 95 family members, and 125 health and social care professionals. Studies took place in Australia, Canada, United Kingdom (UK), and the United States of America (US). Four themes were identified as factors influencing the experience and outcomes of the transition from the perspectives of stakeholders; preparing for transition; quality of communication; the quality of care; family engagement and roles. Conclusion This systematic review presents a compelling case for the need for robust evidence to guide best practice in this important area of multi-disciplinary clinical practice. The evidence suggests this transition is challenging for all stakeholders and that people with dementia have specific needs which need attention during this period. Trial registration PROSPERO Registration Number: CRD42017082041.
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Røen I, Stifoss-Hanssen H, Grande G, Kaasa S, Sand K, Knudsen AK. Supporting carers: health care professionals in need of system improvements and education - a qualitative study. BMC Palliat Care 2019; 18:58. [PMID: 31311536 PMCID: PMC6636145 DOI: 10.1186/s12904-019-0444-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/10/2018] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background Health care professionals should prevent and relieve suffering in carers of patients with advanced cancer. Despite known positive effects of systematic carer support, carers still do not receive sufficient support. Carers have reported to be less satisfied with coordination of care and involvement of the family in treatment and care decisions than patients. In a rural district of Mid-Norway, cancer palliative care services across specialist and community care were developed. Participants’ experiences and opinions were investigated as part of this development process. Methods The aim of this qualitative study was to explore and describe health care professionals’ experiences with carer support from their own perspective. Data were collected in focus groups. Purposeful sampling guided the inclusion. Six groups were formed with 21 professionals. The discussions were audio-recorded, transcribed, and analyzed using systematic text condensation. Results In the analyzis of the focus group discussions, ten categories emerged from the exploration of health care professionals’ carer support, assessment of needs, and factors hampering carer support: 1) dependent on profession, role, and context, 2) personal relationship, 3) personal skills and competence, 4) adjusted to the stage of the disease, 5) informal assessment of carers’ needs, 6) lack of education 7) lack of systems for carer consultations, 8) lack of systems for documentation, 9) lack of systems for involving GPs, and 10) lack of systematic spiritual care. Conclusions Health care professionals built a personal relationship with the carers as early as possible, to facilitate carer support throughout the disease trajectory. Systematic carer support was hampered by lack of education and system insufficiencies. Organizational changes were needed, including 1) education in carer support, communication, and spiritual care, 2) use of standardized care pathways, including systematic carer needs assessment, 3) systematic involvement of general practitioners, and 4) a system for documentation of clinical work with carers.
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Affiliation(s)
- Ingebrigt Røen
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 4. etg. Kunnskapssenteret vest, St. Olavs hospital, 7006, Trondheim, Norway. .,St. Olavs hospital HF, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs hospital, 7006, Trondheim, Norway.
| | - Hans Stifoss-Hanssen
- Center of diakonia and professional practice, VID Specialized University, Oslo, Norway
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, England
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Kari Sand
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 4. etg. Kunnskapssenteret vest, St. Olavs hospital, 7006, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
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Berwig M, Lessing S, Deck R. Telephone-based aftercare groups for family carers of people with dementia: study protocol of the Talking Time - REHAB project. BMC Health Serv Res 2019; 19:183. [PMID: 30898114 PMCID: PMC6427887 DOI: 10.1186/s12913-019-4003-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/11/2019] [Indexed: 11/03/2022] Open
Abstract
Background More than one million people in Germany live with dementia. Most of these people are cared for at home in the family setting. Supporting and caring for people with dementia is time-consuming, and family carers often have high stress levels and are at an increased risk of becoming physically and mentally ill. Medical rehabilitation (rehab) helps to relieve family carers and provide them with strategies to cope with stress. The aim of this study is to improve the sustainability of a multimodal rehab program for family carers of people with dementia. Research question: can the effects of this rehab be maintained through telephone-based aftercare groups following the rehab program? Methods A prospective randomized controlled longitudinal trial is performed. The intervention group (IG) participates in telephone-based aftercare groups; the control group (CG) receives treatment as usual. For evaluation, a mixed-methods approach is used. The effects of the intervention are quantitatively evaluated by written questionnaires at four measuring points (pre- and post-rehab, as well as 6 and 12 months after the end of rehab). Primary outcome: participation (IMET). Secondary outcomes: Depressive Mood State CES-D, General Complaints SCL-90-R, Subjective Quality of Life WHOQUOL-BREF, Social Support F-SozU, performance in different areas of life, single scales, and support offers (single items). The intervention process is evaluated through qualitative interviews and focus groups with regard to the acceptance of and satisfaction with the aftercare offered; in addition, a health economic evaluation is performed using the EQ-5D questionnaire. Rehabilitants are included in the study (N = 103 each in the IG and CG) who, accompanied by their family members with dementia, participate in the rehab measure in Ratzeburg. The IG participates monthly in 6 telephone aftercare groups over a period of 6 months. Typical stress situations are discussed and worked on. Discussion Upon successful evaluation, the offer to participate in telephone-based aftercare groups can be firmly established in the participating rehab clinic. Through minor adjustments, the offer would also be suitable for carers of physically ill people and for non-nursing-specific rehabilitation indications. Trial registration German Clinical Trials Register: DRKS00013736, May 14, 2018.
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Affiliation(s)
- Martin Berwig
- Clinic for Cognitive Neurology, Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Susanne Lessing
- Clinic for Cognitive Neurology, Medical Faculty, University of Leipzig, Leipzig, Germany.,Rehabilitation Clinic for Family Carers, AMEOS Rehab Clinical Centre Ratzeburg, Ratzeburg, Germany
| | - Ruth Deck
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
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Lodder A, Papadopoulos C, Randhawa G. Stigma of living as an autism carer: a brief psycho-social support intervention (SOLACE). Study protocol for a randomised controlled feasibility study. Pilot Feasibility Stud 2019; 5:34. [PMID: 30858984 DOI: 10.1186/s40814-019-0406-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 01/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Stigma is prominent in the lives of autistic individuals and their families and contributes significantly to the challenges faced by families raising an autistic child. Parents and carers can feel blamed for their child's behaviour, feel socially excluded and isolated and suffer from low self-esteem and poor psychological well-being. This increases the risk of experiencing self-stigma which further exacerbates these and other negative consequences. Therefore, there is a need for interventions that help parents/family carers cope with autism-related stigma as well as prevent the internalisation of stigma. Objectives The primary objective of this study is to assess the feasibility and acceptability of a stigma support intervention for parents and carers of autistic children titled 'Stigma of Living as an Autism Carer (SOLACE)'. The secondary objective is to explore the preliminary impact of the intervention on the mental health of the parents and carers. Methods A pilot randomised controlled trial feasibility study will be implemented. A group receiving the SOLACE stigma support intervention (n = 12) will be compared against a control group not receiving any additional intervention (n = 12). Family carers of autistic children up to the age of 10, who have been recently diagnosed or are currently undergoing diagnosis, will be recruited for the study. Participants will be randomly allocated to the intervention or control group and will take part in eight weekly group-based sessions designed to improve the well-being of the parents primarily through increasing their resilience to stigma. Feasibility will be determined by recruitment and retention rates and a qualitative focus group evaluating the acceptability of the intervention and outcome measures. The primary outcome of interest is psychological well-being, and depending on the normality of distribution, independent samples T tests will be used to compare the outcome scores between the two groups and dependent samples T tests for differences within the group. Other outcomes of interest are stigma, self-stigma, self-esteem, self-blame, social isolation, self-compassion and perceived responsibility and control. Discussion Results from the feasibility randomised controlled trial will be used to refine the study protocol and inform the design of an intervention for future use in a larger, powered trial. SOLACE could potentially improve the psychological well-being of parents/family carers of autistic children through increased resistance to stigma. Trial registration ISRCTN Registry number ISRCTN61093625 (October 13, 2017).
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Duggleby W, Jovel Ruiz K, Ploeg J, McAiney C, Peacock S, Nekolaichuk C, Holroyd-Leduc J, Ghosh S, Brazil K, Swindle J, Forbes D, Woodhead Lyons S, Parmar J, Kaasalainen S, Cottrell L, Paragg J. Mixed-methods single-arm repeated measures study evaluating the feasibility of a web-based intervention to support family carers of persons with dementia in long-term care facilities. Pilot Feasibility Stud 2018; 4:165. [PMID: 30410783 PMCID: PMC6208108 DOI: 10.1186/s40814-018-0356-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/15/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Following institutionalization of a relative with Alzheimer disease and related dementias (ADRD), family carers continue to provide care. They must learn to negotiate with staff and navigate the system all of which can affect their mental health. A web-based intervention, My Tools 4 Care-In Care (MT4C-In Care) was developed by the research team to aid carers through the transitions experienced when their relative/friend with ADRD resides in a long-term care (LTC) facility. The purpose of this study was to evaluate MT4C-In Care for feasibility, acceptability, ease of use, and satisfaction, along with its potential to help decrease carer's feelings of grief and improve their hope, general self-efficacy, and health-related quality of life. METHODS The study was a mixed-methods single-arm repeated measures feasibility study. Participants accessed MT4C-In Care over a 2-month period. Data were collected at baseline and 1 and 2 months. Using a checklist, participants evaluated MT4C-In Care for ease of use, feasibility, acceptability, and satisfaction. Measures were also used to assess the effectiveness of the MT4C-In Care in improving hope (Herth Hope Index), general self-efficacy (GSES), loss and grief (NDRGEI), and health-related quality of life (SF12v2) of participants. Qualitative data were collected at 2 months and informed quantitative findings. RESULTS The majority of the 37 participants were female (65%; 24/37), married (73%; 27/37), and had a mean age of 63.24 years (SD = 11.68). Participants reported that MT4C-In Care was easy to use, feasible, and acceptable. Repeated measures ANOVA identified a statistically significant increase over time in participants hope scores (p = 0.03) and a significant decrease in grief (< 0.001). Although significant differences in mental health were not detected, hope (r = 0.43, p = 0.03) and grief (r = - 0.66, p < 0.001) were significantly related to mental health quality of life. CONCLUSION MT4C-In Care is feasible, acceptable, and easy to use and shows promise to help carers of family members with ADRD residing in LTC increase their hope and decrease their grief. This study provides the foundation for a future pragmatic trial to determine the efficacy of MT4C-In Care. TRIAL REGISTRATION ClinicalTrials.gov NCT03571165. June 30, 2018 (retrospectively registered).
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Affiliation(s)
- Wendy Duggleby
- Nursing Research Chair Aging and Quality of Life, Innovations in Seniors Care Research Unit, Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Kathya Jovel Ruiz
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- School of Public Health and Health Systems, Schlegel Research Chair in Dementia, Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON N2l 3G1 Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, 4340 E-wing Health Sciences104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, University of Alberta, c/o Palliative Institute, 404, Health Services Centre, 1090 Youville Drive West, Edmonton, AB T6L 0A3 Canada
| | - Jayna Holroyd-Leduc
- Section of Geriatric Medicine, Cumming School of Medicine, Brenda Strafford Foundation Chair of Geriatric Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB T2N 2T9 Canada
| | - Sunita Ghosh
- Department of Medical Oncology/Department of Mathematical and Statistical Sciences, University of Alberta, 11560 University Avenue, Edmonton, AB T6G 1Z2 Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Jennifer Swindle
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Dorothy Forbes
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 5B9 Canada
| | - Sandra Woodhead Lyons
- Institute for Continuing Care Education and Research (ICCER), 4-023 Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Avenue NW, Edmonton, AB T6G 1C9 Canada
| | - Jasneet Parmar
- Department of Family Medicine University of Alberta, CH Network of Excellence in Seniors’ Health and Wellness, Home Living and Transitions, AHS EZ Continuing Care, c/o Grey Nuns Community Hospital, 416 St. Marguerite Health Services Centre, 1090 Youville Drive West, Edmonton, AB T6L 0A3 Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Laura Cottrell
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Jillian Paragg
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
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Mak WWS, Chan RCH, Yau SSW. Development and validation of Attitudes towards Recovery Questionnaire across Chinese people in recovery, their family carers, and service providers in Hong Kong. Psychiatry Res 2018; 267:48-55. [PMID: 29883860 DOI: 10.1016/j.psychres.2018.05.047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/26/2018] [Accepted: 05/21/2018] [Indexed: 11/27/2022]
Abstract
Considering the lack of existing measures on attitudes toward personal recovery and the need to acknowledge the cultural milieu in recovery attitude assessment, the present study developed and validated the Attitudes towards Recovery Questionnaire (ARQ) in a sample of people in recovery of mental illness, family carers, and mental health service providers in Hong Kong. The ARQ was developed based on existing literature and measures of recovery, and focus group discussions with various stakeholders. Findings of the multi-sample confirmatory factor analyses supported a five-factor structure: (1) resilience as a person in recovery, (2) self-appreciation and development, (3) self-direction, (4) family involvement, and (5) social ties and integration. The ARQ was positively correlated with recovery outcomes, empowerment, recovery knowledge, and recovery orientation of mental health services. As a tool for examining recovery attitudes, the ARQ informs us of the mindset across stakeholders and areas that need enhancement to facilitate the recovery process.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Randolph C H Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Sania S W Yau
- New Life Psychiatric Rehabilitation Association, Kowloon, Hong Kong
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Ateş G, Ebenau AF, Busa C, Csikos Á, Hasselaar J, Jaspers B, Menten J, Payne S, Van Beek K, Varey S, Groot M, Radbruch L. "Never at ease" - family carers within integrated palliative care: a multinational, mixed method study. BMC Palliat Care 2018; 17:39. [PMID: 29490657 PMCID: PMC5831577 DOI: 10.1186/s12904-018-0291-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 03/29/2017] [Accepted: 02/20/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Family carers manage a wide range of responsibilities in the lives and care of patients receiving palliative care. They fulfil multiple roles and perform activities within different settings. This has immediate consequences on family carers' every-day lives. According to literature, family carers in palliative care are both part of the formal and informal care network, but also persons in need of support. This article aims to investigate 1) burdens and rewards associated with family caregiving and 2) what family carers find helpful in their contact with professionals from integrated palliative care initiatives (IPC-i) and other services. METHODS Family carers looking after patients with cancer, chronic obstructive pulmonary disease or chronic heart failure were purposefully recruited at 22 IPC-i in Belgium, Germany, Hungary, the Netherlands and the United Kingdom in the course of the project "Patient-centred palliative care pathways in advanced cancer and chronic disease" (InSup-C). Semi-structured interviews (n = 156) and 87 quantitative questionnaires (CRA, POS, CANHELP Lite) were conducted with family carers. Interviews were analysed with transnationally agreed thematic codes (MAXQDA or NVivo). Statistical tests (SPSS) were carried out in accordance with the characteristic value of the items and distributions. RESULTS On average, quantitative data showed moderate burden, but the qualitative findings indicated that this burden might be underrated. There is some evidence that IPC-i with well-developed professional care networks and communication systems relieved family carers' burden by direct and indirect interventions; e.g. provision of night shift nurses or psychological support. Needs of family carers were similar in all participating countries. However, in all countries IPC-i mostly offered one-off events for family carers, lacking systematic or institutionalised support structures. CONCLUSIONS Data suggest that, most IPC-i did not pay enough attention to the needs of most family carers, and did not offer proactive care and access to supportive resources to them (e.g. training, respite care, access to resources). We recommend recognizing family carers as part of the 'unit of care' and partner in caregiving, to improve their knowledge about, and access to, and the support available.
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Affiliation(s)
- Gülay Ateş
- Department of Palliative Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Anne Frederieke Ebenau
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, P.O. Box 9101 (internal code 549), 6500 Nijmegen, HB Netherlands
| | - Csilla Busa
- Department of Hospice and Palliative Care, Institution of Primary Health Care, University of Pecs Medical School, Szigeti str 12, Pécs, H-7624 Hungary
| | - Ágnes Csikos
- Department of Hospice and Palliative Care, Institution of Primary Health Care, University of Pecs Medical School, Szigeti str 12, Pécs, H-7624 Hungary
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, P.O. Box 9101 (internal code 549), 6500 Nijmegen, HB Netherlands
| | - Birgit Jaspers
- Department of Palliative Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
- Center of Palliative Care, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Von-Hompesch-Straße 1, Bonn, 53123 Germany
| | - Johan Menten
- Radiation Oncology Department and Palliative Care, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Sheila Payne
- Division of Health Research, International Observatory on End of Life Care, Lancaster University, Furness Building, Lancaster, LA1 4YG UK
| | - Karen Van Beek
- Radiation Oncology Department and Palliative Care, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Sandra Varey
- Division of Health Research, International Observatory on End of Life Care, Lancaster University, Furness Building, Lancaster, LA1 4YG UK
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, P.O. Box 9101 (internal code 549), 6500 Nijmegen, HB Netherlands
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
- Center of Palliative Care, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Von-Hompesch-Straße 1, Bonn, 53123 Germany
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Holthe T, Jentoft R, Arntzen C, Thorsen K. Benefits and burdens: family caregivers' experiences of assistive technology (AT) in everyday life with persons with young-onset dementia (YOD). Disabil Rehabil Assist Technol 2017; 13:754-762. [PMID: 28891356 DOI: 10.1080/17483107.2017.1373151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 10/18/2022]
Abstract
BACKGROUND People with dementia and their family caregivers may benefit from assistive technology (AT), but knowledge is scarce about family carers' (FC) experiences and involvement in the use of AT in everyday life. AIM To examine the FC roles and experiences with AT as means of supporting people with young onset-dementia (YOD). METHOD Qualitative interview study with follow-up design. Repeated semi-structured interviews were conducted with 13 FC of people with YOD, participating in an ongoing intervention study investigating the families' use and experiences of AT in everyday life. RESULTS Six main themes emerged: (1) timely information about AT; (2) waiting times; (3) AT incorporated into everyday living; (4) AT experienced as a relief and burden; (5) appraisal of AT qualities and (6) the committed caregiver. CONCLUSIONS The study found benefits for the FC, especially with simply designed AT, but also several barriers for successful use. A committed caregiver is vital throughout the process. Users will need professional advice and support, and occupational therapists may have a significant role in the process. Interventions implementing AT must be based on analysis of the needs of the person with YOD and the carers: their capabilities, preferences, embodied habits, and coping strategies. Implications for Rehabilitation Committed family carers (FC) play an important, often decisive, role in providing support for the person with young-onset dementia (YOD, onset <65 years) to use and benefit from the AT. The simpler the AT, the better. The AT should be introduced at "the right time", before the cognitive and adaptive reduction is too great. The "window" for implementation may be short. AT has potential to ease caregiving and give relief for FC. However, many barriers, difficulties and problems must be attended to. A system for individualized support over time is necessary for implementing AT for this group.
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Affiliation(s)
- Torhild Holthe
- a Norwegian National Advisory Unit on Ageing and Health , Tönsberg , Norway
| | - Rita Jentoft
- b Department of Health and Care Sciences, Faculty of Health Sciences , The Arctic University of Norway , Tromsö , Norway
| | - Cathrine Arntzen
- b Department of Health and Care Sciences, Faculty of Health Sciences , The Arctic University of Norway , Tromsö , Norway
| | - Kirsten Thorsen
- c Norwegian National Advisory Unit on Ageing and Health , Oslo , Norway
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Grande GE, Austin L, Ewing G, O'Leary N, Roberts C. Assessing the impact of a Carer Support Needs Assessment Tool (CSNAT) intervention in palliative home care: a stepped wedge cluster trial. BMJ Support Palliat Care 2017; 7:326-334. [PMID: 26719349 PMCID: PMC5574387 DOI: 10.1136/bmjspcare-2014-000829] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 02/27/2015] [Revised: 09/02/2015] [Accepted: 11/25/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To test the impact on family carers of a Carer Support Needs Assessment Tool (CSNAT) intervention to facilitate carer-led assessment and support during end of life care. METHOD Mixed method, part-randomised, stepped wedge cluster trial with 6 palliative home care services comparing carers receiving the intervention with those receiving standard care. Postal survey with carers 4-5 months postbereavement measured adequacy of end of life support, current mental and physical health (Short Form 12 Health Survey SF-12), level of grief (Texas Revised Inventory of Grief, TRIG) and distress (Distress Thermometer, DT), place of death and carer satisfaction with place of death. RESULTS Surveys were sent to 3260 (76%) carers of 4311 deceased patients; 681 (21%) were returned (N=333 control, N=348 intervention). Compared with controls, intervention carers had significantly lower levels of early grief, better psychological and physical health, were more likely to feel the place of death was right, and patients were more likely to die at home. However, differences were small and process measures showed low level of implementation, indicating differences may partially relate to increased awareness of carer issues rather than a direct impact of the intervention. CONCLUSIONS Carers had better outcomes in the intervention condition, albeit modest. If this can be achieved through low level implementation and awareness raising of carers' needs from implementation activities, substantial impact should be possible if the CSNAT intervention can be fully implemented with a majority of carers. The study illustrates challenges of implementing and testing a complex intervention in real-life practice and of achieving comprehensive carer assessment and support in line with government recommendations.
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Affiliation(s)
- Gunn Eli Grande
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Lynn Austin
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Neil O'Leary
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Chris Roberts
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
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Abstract
Cigarette smoking poses significant health burdens for people with mental illness. They die sooner than they should, and smoking is a major contributor to their high rates of morbid chronic physical health conditions and early mortality, compared to the general population. Family carers provide important support to people with mental illness. However, family carers' perspectives of smoking by their family members with mental illness are largely absent from the research literature and from practice, despite smoking rates remaining high and quit rates remaining low for this population. We know little about how family carers are or could be involved in supporting people with mental illness who smoke to stop smoking. This paper aims to provide a discussion of the opportunities for family carers to support their family member's smoking cessation and a discussion of our preliminary research on this topic. From the available literature, it appears that family carers are well placed to support smoking cessation for this population; however, they struggled physically, philosophically, and emotionally with perceived responsibilities involving their family member's smoking and the caring role. They felt isolated and asserted that there was limited support from service providers to assist them. We concluded that family carers are important agents within the person's immediate environment who could help them to improve their smoking cessation success. This suggests also that mental health services and other health service providers could benefit from including family carers in their efforts to support smoking cessation for people with mental illness who smoke.
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Affiliation(s)
- Sharon Lawn
- a Flinders Human Behavior and Health Research Unit , Department of Psychiatry , School of Medicine, Flinders University , Adelaide , South Australia , Australia
| | - Jenny Bowman
- b School of Psychology , Faculty of Science and Information Technology, University of Newcastle , Newcastle , New South Wales , Australia
| | - Paula Wye
- b School of Psychology , Faculty of Science and Information Technology, University of Newcastle , Newcastle , New South Wales , Australia
| | - John Wiggers
- c School of Medicine and Public Health , Faculty of Health and Medicine, University of Newcastle , Newcastle , New South Wales , Australia.,d Hunter New England Population Health , NSW Health Hunter New England Local Health District , Newcastle , New South Wales , Australia
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Navarta-Sánchez MV, Caparrós N, Ursúa Sesma ME, Díaz de Cerio Ayesa S, Riverol M, Portillo MC. [Psychosocial strategies to strengthen the coping with Parkinson's disease: Perspectives from patients, family carers and healthcare professionals]. Aten Primaria 2017; 49:214-23. [PMID: 27566906 DOI: 10.1016/j.aprim.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/20/2022] Open
Abstract
Objetivo Explorar los principales aspectos psicosociales que influyen en el afrontamiento de la enfermedad de los pacientes con enfermedad de Parkinson (EP) y sus familiares cuidadores. Diseño Estudio cualitativo exploratorio que constituye la segunda fase de un proyecto de metodología combinada. Emplazamiento Estudio multicéntrico realizado en la Comunidad Autónoma de Navarra en 2014 con la colaboración de Atención Primaria del Servicio Navarro de Salud-Osasunbidea, la Clínica Universidad de Navarra y la Asociación Navarra de Parkinson. Participantes Un total de 21 participantes: 9 personas con EP, 7 familiares cuidadores y 5 profesionales sociosanitarios. Método Los participantes fueron seleccionados mediante muestreo opinático. Se realizaron grupos focales hasta que se consideró adecuada la saturación de los datos. Las transcripciones fueron analizadas por 2 investigadores a través de un análisis de contenido. Resultados Se identificaron 3 aspectos que influían en cómo pacientes y familiares afrontaban la EP: funcionalidad de la atención sanitaria; entorno familiar, y aceptación de la enfermedad. Considerando estos resultados, se proponen estrategias que podrían promover estos aspectos desde atención primaria, para así mejorar la adaptación a esta enfermedad en pacientes y en sus familiares cuidadores. Conclusiones La atención sociosanitaria de las personas con EP debería adoptar un enfoque integral que aborde el control de los síntomas del paciente y que responda también a los aspectos psicosociales que influyen en el afrontamiento de la enfermedad, tanto en los pacientes como en sus familiares cuidadores.
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Saini G, Sampson EL, Davis S, Kupeli N, Harrington J, Leavey G, Nazareth I, Jones L, Moore KJ. An ethnographic study of strategies to support discussions with family members on end-of-life care for people with advanced dementia in nursing homes. BMC Palliat Care 2016; 15:55. [PMID: 27388766 PMCID: PMC4936120 DOI: 10.1186/s12904-016-0127-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 03/24/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most people with advanced dementia die in nursing homes where families may have to make decisions as death approaches. Discussions about end-of-life care between families and nursing home staff are uncommon, despite a range of potential benefits. In this study we aimed to examine practices relating to end-of-life discussions with family members of people with advanced dementia residing in nursing homes and to explore strategies for improving practice. METHODS An ethnographic study in two nursing homes where the Compassion Intervention was delivered. The Compassion Intervention provides a model of end-of-life care engaging an Interdisciplinary Care Leader to promote integrated care, educate staff, support holistic assessments and discuss end of life with families. We used a framework approach, undertaking a thematic analysis of fieldwork notes and observations recorded in a reflective diary kept by the Interdisciplinary Care Leader, and data from in-depth interviews with 23 informants: family members, GPs, nursing home staff, and external healthcare professionals. RESULTS Four major themes described strategies for improving practice: (i) educating families and staff about dementia progression and end-of-life care; (ii) appreciating the greater value of in-depth end-of-life discussions compared with simple documentation of care preferences; (iii) providing time and space for sensitive discussions; and (iv) having an independent healthcare professional or team with responsibility for end-of-life discussions. CONCLUSIONS The Interdisciplinary Care Leader role offers a promising method for supporting and improving end-of-life care discussions between families of people with advanced dementia and nursing home staff. These strategies warrant further evaluation in nursing home settings.
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Affiliation(s)
- Geena Saini
- Centre for Mental Health, Maya House, 134-138 Borough High Street, London, SE1 1LB, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Magee Campus, Northland Road, Derry Londonderry, BT48 7JL, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, UCL Royal Free Site, Rowland Hill Street, London, NW3, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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Milligan C, Turner M, Blake S, Brearley S, Seamark D, Thomas C, Wang X, Payne S. Unpacking the impact of older adults' home death on family care-givers' experiences of home. Health Place 2016; 38:103-11. [PMID: 26916987 DOI: 10.1016/j.healthplace.2016.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 10/05/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
Public Health England (2013) survey data indicates that while the place of death is geographically uneven across England, given a choice, many older people nearing end of life would prefer to die at home. There is, however, a growing critique that policies designed to support home death fail to understand the needs and preferences of older people and the impact on family carers. Such policies also make assumption about within whose home the home death takes place. Hence, there are major gaps in our understanding of firstly, where and how care work undertaken by family members within domestic settings takes place; and secondly, how it can create tensions between home and care that fundamentally disrupt the physical and socio-emotional meaning of home for family carers, impacting on their sense of home post-death. This can have consequences for their own well-being. In this paper we draw on interview data from our 'Unpacking the Home' study to elicit an in-depth understanding of how facilitating a home death can create an ambiguity of place for family carers, where the issues faced by them in caring for a dying older person at home, and the home death itself, can fundamentally reshape the meaning and sense of home.
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Sin J, Murrells T, Spain D, Norman I, Henderson C. Wellbeing, mental health knowledge and caregiving experiences of siblings of people with psychosis, compared to their peers and parents: an exploratory study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1247-55. [PMID: 27121259 PMCID: PMC5025483 DOI: 10.1007/s00127-016-1222-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/16/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The wellbeing and caregiving experiences of family carers supporting people with psychosis has garnered increasing interest. Evidence indicates that the burden of caregiving can adversely impact on parents' wellbeing, few studies have investigated whether this is also the case for siblings, who often take on caregiving responsibilities. This exploratory study investigated the wellbeing, mental health knowledge, and appraisals of caregiving in siblings of individuals with psychosis. METHOD Using a cross-sectional design, 90 siblings completed three validated questionnaires: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), Mental Health Knowledge Schedule (MAKS), and Experience of Caregiving Inventory (ECI). Data obtained were compared to general population norms and parent-carers' scores. Multi-variable regression analyses were conducted to examine relationships between questionnaire scores and demographic characteristics including age, sex, birth order, marital status, accommodation and educational level. RESULTS Siblings, especially sisters, had significantly poorer mental wellbeing, compared to normative scores. Conversely, they had better mental health knowledge. Siblings and parent-carers had comparable high levels of negative appraisals of caregiving experiences, but siblings reported more satisfaction with personal experiences and relationships. Education level was a significant predictor for better mental health knowledge; there were no other relationships between siblings' demographic factors and outcomes. CONCLUSION Study findings suggest that siblings have overlapping as well as distinct needs, compared to parent-carers. Further research is required to better understand siblings' experiences so as to inform development of targeted interventions that enhance wellbeing and caregiving capacity.
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Affiliation(s)
- Jacqueline Sin
- Health Service and Population Research Department, David Goldberg Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 de Crespigny Park, London, SE5 8AF, UK.
- Population Health Research Institute, St George's, University of London, London, UK.
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Debbie Spain
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Norman
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Claire Henderson
- Health Service and Population Research Department, David Goldberg Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 de Crespigny Park, London, SE5 8AF, UK
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