Psychosocial Well-Being of Older Spouses During End-of-Life Caregiving for Their Partners With Cancer: A Phenomenological Study.

Specific burdens of older spousal caregivers often remain invisible, and spousal caregivers rarely receive the support they need to perform their role. To provide suitable support for spousal caregivers, it is crucial to develop a comprehensive understanding of their well-being, particularly during end-of-life caregiving. The aim of the current study was to gain more insight into the psychosocial well-being of older spouses engaged in end-of-life caregiving for their partners with cancer. This qualitative study uses a phenomenological approach with in-depth interviews conducted with older (aged ≥65 years) spousal caregivers of individuals who died of cancer. Eleven spouses participated in the study. Strains on psychosocial well-being during end-of-life caregiving fell into four major themes: The Disease Itself, The Caregiving Process, The Partner Relationship, and Support From Others. Results suggest that older spousal caregivers are experiencing issues that might be more pronounced due to their older age, for example, physical and emotional exhaustion and loneliness. Providing care is time-consuming and often leads to a reduced social network, which enhances loneliness. Moreover, as relationships with ailing partners changed and communication deteriorated, participants reported feeling more like a caregiver rather than a partner. [Journal of Gerontological Nursing, 48(6), 33-39.].

Using Liminality and Subjunctivity to Better Understand How Patients With Cancer Experience Uncertainty Throughout Their Illness Trajectory.

Uncertainty is a central theme in the illness experiences of older cancer patients throughout their illness trajectory. Mishel's popular theory on uncertainty during illness approaches uncertainty as an outcome and is characterized by the patient's inability to find meaning in illness events. This study used the concepts of liminality and subjunctivity to explore uncertainty throughout the illness trajectory of cancer patients. We interviewed 18 older (age range = 57-92 years) patients with breast cancer or gastro-intestinal cancer 3 to 4 years post diagnosis. Our analysis is based on the QUAGOL guide that draws on elements of grounded theory such as constant comparison. We found that liminality and subjunctivity provide a useful frame for understanding uncertainty with a specific focus on its productive potential and meaning making. Health care professionals should be open to acquiring a complete picture of patients' diverse and dynamic experiences of uncertainty in the different stages of their illness trajectory.

Prevalence and predictors of psychosocial problems in informal caregivers of older cancer survivors - A systematic review: Still major gaps in current research.

Despite the abundance of studies concerning caring for patients with cancer, less is known about caring for an older cancer survivor (≥65 years). We aimed to systematically gather literature about the psychosocial well-being of caregivers of older cancer survivors and to identify possible risk factors for developing psychosocial problems. Fourteen articles met the following inclusion criteria: articles about (a) cancer, (b) informal caregivers, (c) older survivors and a (d) curative setting. After critical appraisal, nearly all were considered to be of moderate-to-strong quality. This results mainly from the specific study population, the valid and reliable measurement instruments and the appropriate statistical methods used in the articles. Main outcomes were burden, depression, anxiety, self-esteem, distress, communication issues, stress and QoL. For all these outcomes, measurement instruments and timing of measurements vary. Also, the results on studied predictors vary widely or not all of them were described in the reviewed articles. There seems to be a higher prevalence of distress, lower QoL and more anxiety in informal caregivers of older cancer survivors compared with the general population, but all were understudied. Based on these results and more focused future research, specific and qualitative support for this group of caregivers can be developed.

Mood disorders in higher education in Flanders during the 2nd and 3rd COVID-19 wave: Prevalence and help-seeking: Findings from the Flemish College Surveys (FLeCS).

To examine the prevalence of 12-month mood disorders and receipt of mental health treatment among a volunteer sample of higher education students during the 2nd and 3rd COVID-19 wave in the Flanders region. Web-based self-report surveys were obtained from 9101 students in higher education in the Flemish College Surveys (FLeCS) in Flanders, Belgium. As part of the World Health Organization's World Mental Health-International College Student Initiative, we screened for 12-month mood disorders (major depressive episode (MDE), mania/hypomania), and service use. We used poststratification weights to generate population-representative data on key socio-demographic characteristics. 50.6% of the respondents screened positive for 12-month mood disorders (46.8% MDE, of which 22.9% with very severe impact). Use of services was very low, with estimates of 35.4% for MDE, 31.7% for mania, and 25.5% for hypomania. Even among students with very severe disorders, treatment rates were never higher than 48.3%. Most common barriers for not using services were: the preference to handle the problem alone (83.4%) and not knowing where to seek professional help (79.8%). We found a high unmet need for mood problems among college students; though caution is needed in interpreting these findings given the volunteer nature of the sample. A reallocation of treatment resources for higher education students should be considered, particulary services that focus on innovative, low-threshold, and scalable interventions.

Supporting an informal care group - Social contacts and communication as important aspects in the psychosocial well-being of informal caregivers of older patients in Belgium.

BACKGROUND: Increasingly, informal caregivers in Belgium care in group for an older patient. This study aimed to decrease the caregiver burden and to increase the well-being of caregivers and patients by supporting the needs of informal care groups of older patients (≥70 years). METHOD: Through an online self-management tool, the groups were supported to make informed choices concerning the care for the older patient, taking into account the standards, values, concerns and needs of every caregiver and patient. A pre-post study was performed. RESULTS: Although patients and caregivers considered the self-management tool as useful and supportive, no clear evidence for decreased caregiver burden was found. There was a positive trend in group characteristics such as the distribution of tasks, communication and prevalence of conflicts. Caregivers also stated that they took more time for themselves, had less feelings of guilt and experienced less barriers to ask help. CONCLUSION: Tailor-made support of informal care groups starts with facilitating and guiding a process to achieve consent within the group to optimise the care for the patient and also for the caregivers. With a shared vision and supported decisions, caregivers can enter into conversations with the professional caregiver to coordinate adjusted support regarding the care needs.

Caregiver burden: An increasing problem related to an aging cancer population.

This prospective cohort study identified risk factors for the development of caregiver burden and included older cancer survivors, middle-aged cancer survivors, older patients without cancer and their caregivers. Overall, more than 16 per cent of caregivers experienced high-to-severe burden at baseline. This proportion remained stable after 1 and 3 years. Caregivers who experienced increased caregiver burden at baseline were at higher risk maintaining their caregiver burden over the following years. Caregiver burden was not related to the cancer diagnosis but rather to the baseline psychosocial well-being of both the caregiver and patient and the physical condition of the patient.

Positive screens for mental disorders among healthcare professionals during the first covid19 wave in Belgium.

We examined the manifestation of major depressive disorder, generalized anxiety disorder, substance use disorder, post-traumatic stress disorder, and panic attacks among health care professionals during the first COVID-19 wave (n = 6409) by means of mental disorder screening instruments. Logistic regressions were used to gauge individual risk factors; population attributable risk proportions (PARP) were inferred to identify the most important risk factors at the societal level. Data were weighted to represent general profiles of Belgian health care professionals. Lifetime, pre-pandemic emotional problems and work-related factors during the first wave of COVID-19 were strongly associated (mean adjusted odds ratios of 3.79 and 1.47, respectively) with positive screens for current mental disorders (occurrence of 29.3%). Most prominently, the data suggest that disruptions of work-life balance account for more than a quarter of the observed mental health problems due to the combination of widespread occurrence and strong association.

Suicidality among healthcare professionals during the first COVID19 wave.

BACKGROUND: Prevalence estimates of suicidal thoughts and behaviours (STB) among clinically active healthcare professionals during the first wave of COVID19 pandemic are non-existing. The main aim of this study was to investigate the 30-day prevalence of STB and associated risk factors. METHODS: As part of the Recovering Emotionally from COVID study (RECOVID), 30-day STB among healthcare professionals (N = 6,409) was assessed in an e-survey in healthcare settings in Belgium. The prevalence of STB and associated risk factors were estimated in multivariable models with individual-level and society-level measures of association. We used post-stratification weights to make the data representative for the entire clinical workforce in Belgium. RESULTS: Prevalence was 3.6% death wish, 1.5% suicide ideation, 1.0% suicide plan, and 0.0% suicide attempt. Thirty-day STB was (a) increased among respondents with lifetime and current mental disorders (mostly depression) and those hospitalized for COVID19 infection, (b) decreased among respondents with social support, and (c) unrelated to work environment. LIMITATIONS: This is an explorative cross-sectional study using multivariate models that generates specific hypotheses on the prevalence of and risk factors for STB during the COVID19 pandemic rather than testing specific pathways that lead to STB onset. CONCLUSIONS: Across age, gender, professional discipline, and exposure to COVID, lifetime and current mental disorders were highly associated with STB. These factors could guide governments and healthcare organizations in taking up responsibilities in preventing emotional problems and developing resilience among healthcare professionals during, but probably beyond, the current COVID19 pandemic.

You never walk alone: An exploratory study of the needs and burden of an informal care group.

Little is known about the dynamics of a group of people giving informal care together. The aim of this study was to investigate the characteristics of an informal care group, the obstacles the informal care group experiences, the needs and desires they have and how the informal care group can be supported by general practitioners (GPs) and other professionals. Nine informal care groups were interviewed based on a questionnaire that was preapproved by the six Flemish official informal caregiver organisations. The results were analysed using open coding. A survey was conducted among 137 caregivers who were part of a group. Univariate analysis was performed. Informal care group usually consist of close relatives of the patient, with often the partner of the patient as the main caregiver. The size of the informal care group depends on the size of the family. If there are more caregivers in a group, the perceived burden of the individual caregiver decreases. The support of the other caregivers in the group increases capacity. The cooperation and agreements are often spontaneously organised and few problems are reported. There is a large variation in the expectations of support from the general practitioner, ranging from availability in emergencies to information about the possibilities of formal home care. This study depicts a positive image of the informal care group. Being part of a caregiver group both decreases burden and increases capacity. Informal care groups usually function well without a need for formal agreements within the group, and they rarely need a third party to coordinate with them or intervene.

Long-term distress in older patients with cancer: a longitudinal cohort study.

BACKGROUND: Receiving a cancer diagnosis can be a major life event which causes distress even years after primary treatment. AIM: To examine the prevalence of distress in older patients with cancer (OPCs) up until 5 years post-diagnosis, and identify predictors present at time of diagnosis. Results are compared with reference groups of middle-aged patients with cancer (MPCs) and older patients without a cancer diagnosis (OPs). DESIGN & SETTING: OPCs, MPCs, and OPs participated in a longitudinal cohort study in Belgium and the Netherlands by filling in questionnaires at designated time points from 2010-2019. METHOD: Data from 541 patients were analysed using multivariable logistic regression analyses. RESULTS: At baseline, 40% of OPCs, 37% of MPCs, and 17% of OPs reported distress. After 5 years, 35% of OPCs, 23% of MPCs, and 25% of OPs reported distress. No significant predictors for long-term distress in OPCs and OPs were found. For MPCs, it was found that baseline distress (odds ratio [OR] 2.94; 95% confidence intervals [CI] = 1.40 to 6.19) and baseline fatigue (OR 4.71; 95% CI = 1.81 to 12.31) predicted long-term distress. CONCLUSION: Distress is an important problem for people with cancer, with peaks at different moments after diagnosis. Feelings of distress are present shortly after diagnosis but they decrease quickly for the majority of patients. In the long term, however, OPCs in particular appear to be most at risk for distress. This warrants extra attention from primary healthcare professionals, such as GPs who are often patients' first medical contact point. More research into risk factors occurring later in an illness trajectory might shed more light on predictors for development of long-term distress.