Factors Associated With Family Caregiver Burden of Home-Dwelling Patients With Advanced Dementia.

OBJECTIVES: To realize patients' preferences for home death, this study aimed to identify factors associated with family caregiver burden of home-dwelling patients with advanced dementia and examine its relationship with end-of-life care treatment decisions. DESIGN: A prospective cohort study. SETTING AND PARTICIPANTS: Patient-family caregiver dyads enrolled in a home-based palliative care program for patients with advanced dementia, with family caregiver burden assessed using the Zarit Burden Interview (ZBI) on enrolment, were included. METHODS: Independent variables included sociodemographic data, patients' clinical phase, symptom severity, quality of life, informal paid help availability, and community resources utilized. Dependent variable was continuous ZBI scores and ZBI scores dichotomized into <24 and ≥24 for predicting depression risk. Place of death and interventions received 2 weeks before death were also collected. Data were analyzed using multivariate linear and logistic regression. RESULTS: From October 2014 to December 2020, a total of 377 family caregivers were assessed with ZBI. Median score was 25 (IQR 15-36), and 54.4% of them were at risk of depression. Younger family caregivers had higher ZBI scores (ß = -0.22, 95% CI -0.38, -0.07), with the depression risk doubling for family caregivers aged <60 years (OR 2.13, 95% CI 1.33, 3.43). Absence of informal paid help also increased the ZBI scores (ß = -9.04, 95% CI -14.86, -3.22) and depression risk (OR 2.50, 95% CI 1.03, 6.09). In addition, caregivers' ZBI scores increased with patients' neuropsychiatric symptom severity (ß = 0.49, 95% CI 0.08, 0.89), and caregivers of clinically unstable patients had a higher depression risk (OR 1.80, 95% CI 1.03, 3.12). Baseline caregiver burden was not associated with treatment decisions made at the end of life. CONCLUSIONS AND IMPLICATIONS: Younger family caregivers caring for clinically unstable patients with severe neuropsychiatric symptoms experienced greater burden without informal paid help. For end-of-life care at home in advanced dementia to be tenable, relevant national agencies and stakeholders are recommended to work collectively to support family caregivers holistically.

Post-intervention sustainability of a brief psycho-educational support group intervention for family caregivers of cancer patients.

INTRODUCTION: Family caregivers of cancer patients experience many negative effects due to the heavy responsibility involved. Although various psychosocial interventions have been found to improve caregivers' quality of life (QOL), the sustainability of the benefits of these interventions over time has been less consistently investigated and hence less clearly established. Extending previous research on the immediate post-intervention effects, this study aims to examine the trajectories of change in caregivers QOL over an 8-week follow-up period. METHODS: Caregivers of patients attending an outpatient clinic at a cancer center in Singapore were recruited. Participants had to fulfill the following criteria: (a) between 21 and 74 years; (b) willing to attend hour-long weekly programs for 4 weeks; (c) able to understand, speak, and read English; (d) a family member living with and providing care and support for the patient; and (e) provide written informed consent. Participants completed the Caregiver QOL-Cancer scale at baseline, immediately post-intervention, and at 4 and 8 weeks after the end of the intervention. Data from 56 participants were analyzed. RESULTS: Majority of participants exhibited a stable trajectory of change in their QOL, while a small number of participants either improved or declined. DISCUSSION: Understanding the sustainability of the effects of the intervention is important in determining the need to initiate periodic "booster" sessions to provide consistent support for caregivers. Further research could investigate the sustainability over an even longer period, as well as intra-individual change trajectories using growth modeling among a larger sample.

Evaluation of a brief pilot psychoeducational support group intervention for family caregivers of cancer patients: a quasi-experimental mixed-methods study.

BACKGROUND: Family caregivers of cancer patients often experience an impaired quality of life (QOL) and emotional distress as a result of their caregiving duties, which may potentially influence the quality of care of their care recipients. The COPE (Caregivers of cancer Outpatients' Psycho-Education support group therapy) intervention was developed as a response to the lack of work done among family caregivers of ambulatory cancer patients in Asia. This group intervention comprised four weekly sessions simultaneously targeting psychoeducation, skills training, and supportive therapy. The present study sought to evaluate the pilot COPE intervention using both quantitative and qualitative measures. The Hospital Anxiety and Depression Scale (HADS) was used to measure both depression and anxiety, while the Caregiver QOL - Cancer (CQOLC) measured caregiver QOL. These instruments were measured at baseline pre-intervention, and immediately post-intervention. A waitlist control group design was adopted. A subset of caregivers from the intervention group were invited for a semi-structured interview post-intervention. FINDINGS: Quantitative analyses suggest that while QOL remained stable in control group participants, intervention group participants experienced QOL improvements - both in overall QOL and in the specific domain of burden. There were no significant differences in the trajectories of depression and anxiety in both groups. Qualitative analyses suggest that this might have been a result of the intervention not only equipping participants with the relevant coping skills, but also providing a platform for emotional expression and situational reappraisal. CONCLUSIONS: The COPE intervention has shown some efficacy in helping family caregivers of cancer patients, but more work is required before this can be implemented. TRIAL REGISTRATION: Current Controlled Trials NCT02120183 . Registered 17 April 2014. Retrospectively registered.

Longitudinal study of the protective effect of hope on reducing body image distress in cancer patients.

Body image distress is well-documented in patients with cancer, but little is known about the course of body image distress over time and the role of psychosocial resources such as hope. This prospective study sought to explore the dynamics between trajectories of body image distress and hope across time. Cancer patients receiving outpatient treatment at a cancer center completed self-reported measures of body image distress (Body Image Scale) and hope (Adult Hope Scale) at baseline (within three months of their cancer diagnosis) and follow-up (six months post-baseline; N = 111). Trajectories of intra-individual change (improved, stable, and declined) for body image distress were calculated based on the minimal clinically important difference (±0.5 baseline SD). There was a significant increase in body image distress at follow-up (p < .05); hope remained stable. Rank-transformed mixed-factor repeated measures analyses of variance revealed significant interactions between body image distress trajectory groups and time on hope, suggesting that patients experiencing improvements in body image distress reported higher levels of hope than those who had stable or deteriorating levels of body image distress F(2,108) = 3.25, p < .05. The findings of this exploratory study suggest that psychosocial resources like hope may also reduce body image distress across time in a sample of cancer patients, although the mechanisms of interaction require further examination. Supportive care could lend greater focus to improving patients' hope to alleviating body image distress.

Biopsychosocial correlates of hope in Asian patients with cancer: a systematic review.

OBJECTIVE: To examine the factors associated with hope and hopelessness in patients with cancer in Asian countries, and the instruments used to measure hope and hopelessness. METHORDS: A comprehensive systematic review was conducted with search terms, including cancer, hope, hopelessness and individual Asian country names, on CINAHL, Embase, PsycINFO, PubMed and Scopus databases. Only quantitative studies on adult cancer populations in Asia examining hope or hopelessness were included. RESULTS: A total of 2062 unique articles were retrieved from the databases, and 32 studies were selected for inclusion in this review. Hope and hopelessness were most frequently measured with the Herth Hope Index and the Mental Adjustment to Cancer Scale, respectively. The biopsychosocial factors that were most consistently associated with hope and hopelessness included sociodemographic variables (education, employment and economic status); clinical factors (cancer stage, physical condition and symptoms); and psychosocial factors (emotional distress, social support and connections, quality of life, control or self-efficacy, as well as adjustment and resilience). DISCUSSION: There is a need for more studies from South and Southeast Asia as most studies hailed from East Asia. This review highlighted the possibility of cultural differences influencing factors related to hope, suggesting that cross-cultural studies specifically would facilitate understanding behind these variations, although future reviews on hope should also include studies on hopelessness for a comprehensive understanding of the concept. Finally, more longitudinal research could be conducted to assess whether the factors associated with hope and hopelessness change over time and disease progression.

Strengthening Resilience and Reducing Stress in Psychosocial Care for Nurses Practicing in Oncology Settings.

The current study examined whether continuing education programs on psychosocial oncology patient care would improve nurses' resilience and reduce their stress. Analyses revealed postprogram improvements in resilience, which was related to reduction in stress. Findings provide preliminary evidence that such programs may also be helpful in other domains.

Salvia divinorum: An overview of the usage, misuse, and addiction processes.

Salvia divinorum, a sage plant with leaves that can produce a psychoactive high, has been used for hundreds of years for its psycho-mimetic effects in religious rituals in South America. Salvia has now become popular mainly with adolescents and young adults for the short-lived relatively pleasant experiences many consider a "legal high" and its ready availability through Internet purchases. The main (psycho)active compound in salvia is Salvinorin A, a potent κ-opioid agonist and although the short and long-term effects have not been examined in sufficient detail, it is widely believed to have low addictive potential and low toxicity. Recent findings, however, seem to suggest that Salvinorin A can precipitate psychiatric symptoms and negatively affect cognition. Its ready availability and increasingly widespread use requires clinicians to have knowledge and awareness of its effects.

Caring for the caregiver while caring for the patient: exploring the dyadic relationship between patient spirituality and caregiver quality of life.

INTRODUCTION: Caregivers of cancer patients experience much psychological stress due to the heavy responsibility of caregiving. Dyadic studies on the patient-caregiver relationship have shown that caregivers' quality of life (QOL) are affected by their care recipients' psychological variables. In this exploratory study, focus is placed on spirituality in patients--an emerging area of interest--and its impact on their caregivers' QOL. Because of spirituality's links with optimism and resilience, they were also investigated as possible mediators in the dyadic relationship. METHOD: Patients completed measures of spirituality (FACIT-Sp-12), optimism (LOT-R), and resilience (RAS); their family caregivers completed a measure of QOL (CQOLC). Both patients and family caregivers completed a sociodemographic survey. Regression analyses were used to analysis the data. RESULTS: Regression analyses following Baron and Kenny's (1986) mediation framework was carried out. Results indicated that spirituality as a whole did not predict caregiver QOL. However, further analyses showed that while the meaning-making aspect of spirituality did predict caregiver QOL, the faith aspect did not. Mediatory analyses indicated that both optimism and resilience were not mediators; hence, confirmatory Sobel's tests which had been originally planned were not conducted. Nonetheless, optimism and resilience were correlated with meaning-making. DISCUSSION: Patients who make meaning of their cancer illness exert a positive influence on their caregivers' well-being. This provides support for interventions that encourage patients to reappraise their illness situation, as such interventions not only benefit patients but also enhance the quality of life for their caregivers.

The relationships between dysfunctional attitudes, rumination, and non-somatic depressive symptomatology in newly diagnosed Asian cancer patients.

BACKGROUND: Given the high prevalence of cancer patients with comorbid depression, the present study sought to elucidate the relationships between two vulnerability factors, dysfunctional attitudes and rumination, and their influence on non-somatic depressive symptomatology in an Asian cohort of cancer patients. It was hypothesized that all variables of interest would be inter-correlated, and that both dysfunctional attitudes and rumination would mediate one another in influencing non-somatic depressive symptoms. METHODS: A total of 194 recently diagnosed mixed-cancer patients in Singapore (Mage=49.2±9.2years; 68% women; 61% ethnically Chinese), without any comorbid psychiatric diagnosis, completed the Dysfunctional Attitudes Scale Form A, Rumination Responses Scale (comprising brooding and reflective rumination), and Hospital Anxiety and Depression Scale. RESULTS: Correlational analyses revealed that all variables were inter-correlated (rhos[194]=.35-.52). Bootstrapping mediation analyses controlling for gender and treatment received revealed that both brooding and reflective rumination mediated the relationship between dysfunctional attitudes and non-somatic depressive symptoms, and that dysfunctional attitudes also mediated the relationship between both brooding and reflective rumination and non-somatic depressive symptoms. CONCLUSIONS: Findings suggest that, in cancer patients, both dysfunctional attitudes and rumination seem to act upon one other, in a feedback loop, to influence non-somatic depressive symptomatology. Clinicians may therefore have a wider range of treatments to choose from in managing cancer patients with depressive symptomatology.

Efficacy of a brief nurse-led pilot psychosocial intervention for newly diagnosed Asian cancer patients.

PURPOSE: Cancer patients experience distress and high levels of psychosocial concerns. However, in Asian countries like Singapore, patients are often unwilling to seek support and help from mental healthcare professionals, but, instead, are more willing to confide in nurses. This quasi-experimental study developed and tested the efficacy of a brief nurse-led psychosocial intervention to alleviate these patients' distress, minor psychiatric morbidity, and psychosocial concerns. METHODS: The semi-structured intervention comprised 20- to 30-minute face-to-face sessions with trained oncology nurses, monthly for 2 months and then bimonthly for 4 months. Patients received psycho-education on symptoms of stress, anxiety, and depression and counseling and were taught behavioral techniques such as deep breathing, progressive muscle relaxation, and positive self-talk. RESULTS: The results of this study found that patients who received the intervention had reduced distress, depression, and anxiety levels and improved quality of life (QOL) at 6 months. CONCLUSIONS: Although further research is necessary to explore the efficacy and viability of this intervention, findings support brief nurse-led psycho-educational interventions in Asian settings especially for cancer patients reluctant to seek help from mental health professionals.