Introduction
The diagnosis of cancer and its treatment impacts both patients and the individuals providing informal care from day-to-day. The definition of an informal caregiver (IC) varies across studies, but can be summarized as a person who is not paid and provides physical, emotional, or other supportive care services to a patient with cancer (Honea et al., 2008; Romito et al., 2013). The annual cost of uncompensated care provided by ICs is estimated at $300 billion with the figure expected to grow as many treatment regimens shift to outpatient and home settings (Northouse et al., 2010).
Informal caregiving is physically, emotionally, financially and socially demanding on ICs and has been associated with negative health consequences
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that include sleeplessness, anxiety/depression, fear, and hopelessness (Applebaum & Brietbart, 2012; Li & Loke, 2014). Additional physical health problems include cardiovascular disease, poor immune function, and ineffective coping resulting in increased alcohol and tobacco consumption and decreased self-care. As the American population lives longer and the incidence of cancer increases, there is an urgent need to define and implement interventions to reduce caregiver strain and burden (Harding, List, Epiphaniou, & Jones, 2012). Positive coping strategies have been shown to relieve stress, while negative coping has been shown to be harmful to caregiver’s well being. Therefore, open and early communication with patients and their caregivers should be initiated to help decrease tension and develop trusting relationships with the healthcare team (Chow & Coyle, 2011). According to Applebaum & Breitbart (2012), caregiver burden can be described as “a multi-dimensional biopsychosocial reaction resulting from an imbalance of care demands relative to caregivers’ personal time, social roles, physical and emotional states, financial resources, and formal care resources given the other multiple roles they fulfill” (p. 232). In 2009, there were estimated to be over 65 million people in the United States in the role of informal caregiver, with 4 million individuals caring for adult cancer patients alone (Applebaum & Breitbart, 2012; Romito et al., 2013). As a result of this, there has been a growing focus on attending to the needs of informal caregivers of cancer patients. Informal caregivers generally receive little preparation, information, or the proper guidance and skills to perform their vital role. With the increase in the number of ICs, the needs of the patient as well as the IC must be addressed to maintain the optimal health for the caregiver so that in turn they are able to provide the best care possible to the patient (Northouse et al., 2010; Chambers et al., 2014). Patients’ caregivers are often times hidden patients themselves due to declines in their own physical and mental health as a result of their demands working as caregivers. Because oncology nurses spend so much time with patients and their caregivers, they are well positioned to recognize these signs and help to reduce the strain associated with caring for a loved one with cancer (Honea, 2008). As stated by the Agency for Healthcare Research and Quality (AHRQ), the practice guidelines formulated by the Oncology Nursing Society in 2008 and reaffirmed in 2013, recommend cognitive behavioral interventions for practice (Guideline.gov).
According to Honea et al. (2008), cognitive behavioral interventions facilitate the development of a therapeutic relationship between the caregiver and a trained professional, and “teaches self-monitoring, challenges negative thoughts, helps caregivers develop problem-solving abilities by focusing on time management, overload, and emotional reactivity management; and helps the caregiver reengage in pleasant activities and positive experiences” (p. 511). The goals of cognitive behavioral interventions can be best achieved when patients, their families, nursing, and organizations work together to recognize and address the growing issues related to caregiver stress and burden. In order to develop an evidence-based approach to relieving caregiver strain and burden, the PICOT question guiding this proposal is: For oncology patient caregivers, how does an informal caregiver (IC) cognitive behavioral intervention program compared to no formal training or support affect caregiver stress level and self-efficacy within 3 months of …show more content…
intervention? Literature Review A literature search was conducted of the following databases, CINAHL, Cochrane Database of Systemic Reviews, MEDLINE, OVID, and Science Direct for articles published between 2010 and 2015, with the exception of the most current national practice guidelines for evidence-based interventions to reduce caregiver strain and burden that was originally published in 2008 and reaffirmed in 2013.
The search was limited to adult oncology populations with the key search terms informal caregiver, burden, strain, cancer, oncology, intervention, randomized controlled trial, systematic review or meta-analysis. A total of fifteen articles were reviewed with nine included in the summary of evidence (Appendix
A). Article #1 A systematic review by Applebaum and Breitbart (2012), was conducted of 49 studies that evaluated interventions for caregivers of cancer patients. The purpose of the study was to characterize the state of the science of psychosocial interventions for informal cancer caregivers. The samples of the studies reviewed ranged from 8 to 760 participants in various settings across the cancer trajectory. The interventions reviewed were broken down into eight categories: psychoeducation, problem-solving/skill-building, supportive therapy, family/couples therapy, cognitive-behavioral therapy, interpersonal therapy, complementary and alternative medicine, and one qualitative study (N=10) that examined existential therapy (theory-based, hope-focused activities). The results of the 49 studies reviewed were mostly positive, with 65% of them reporting positive improvements in outcomes for ICs and patients, although statistical results were often unreported. Of the studies included in the review, the largest category was of psyhcoeducational interventions, with the studies that provided the most concrete skill-building and educational benefits including pscychoeducational, problem-solving/skill-building and cognitive-behavioral therapy (Applebaum & Breitbart, 2012). The main strengths of this Level I systematic review were its inclusivity of pertinent articles that encompassed interventions across the cancer trajectory, and because there were no limitations to the type of relationship between the IC and the patient (Applebaum & Breitbart, 2012). The authors noted limitations of this systematic review during the recruitment phase, where ICs with higher baseline levels of distress often declined participation, which limited the ability to conclude about the appropriateness of specific interventions across the course of care. The overall validity of this systematic review was achieved through the review of multiple randomized control trials and very few lower level studies. The methods utilized in the literature search included a detailed description of the search criteria as well as the process in which the studies were assessed. However, the results of the individual studies varied related to the specific caregiver intervention strategy explored. Article #2 Harding, List, Epiphaniou and Jones, (2012) conducted a systematic review to determine both the effectiveness of subsequently published intervention studies, and the current state of the science. This review included a total of 33 studies including RCTs, prospective studies, qualitative studies, and observational studies with pre- and post- test measures that evaluated outcomes for caregivers. The sample studies included reported intervention data for informal caregiver of a patient with a diagnosis of cancer or receiving palliative care (Harding et al., 2012). The results from the review identified a significant growth in the number of intervention studies that aim to improve outcomes for informal caregivers with 50% of the studies reporting statistically significant quantitative benefit for the intervention groups (Harding et al., 2012). The strengths of this Level I study included the detailed data analysis of study quality, heterogeneity of the intervention, aims, sample and outcome tools using the Jadad scoring checklist for randomized trials and the study design quality rating system of the Clinical Guidance Outcomes Group (Harding et al., 2012) . Limitations to the study were related to lack of consistent outcome measurements in the various studies. The overall validity of this systematic review was achieved through inclusion of all studies that evaluated interventions aimed at improving caregiver outcomes that were published in peer-reviewed journals, and not included in the original review. The methods utilized in the literature search included a detailed description of the search criteria as well as the process in which the studies were assessed. Although this review noted an increase in the number of reviews of informal caregiver interventions, the outcomes measured and mechanisms of interventions varied among studies.
...s and carers) will share in the cost of pain and suffering, treatment and other out-of-pocket expenses, lost income and funeral costs. Employers may be confronted with absenteeism, productivity loss, idle assets or potential rehiring and retraining of replacements (Cancer Council, Cost of Cancer in NSW). This has flow-on effects to end consumers who must pay more for goods and services to cover this cost. Similarly, the government loses taxation revenue from lost income, and must provide services such as welfare, respite/palliative care and education (Cancer Council, Cost of Cancer in NSW). Finally, the rest of society such as non-government organisations and charities pick up the cost of community programs and education(Cancer Council, Cost of Cancer in NSW). This indicates that CRC ultimately has a pervasive scope, affecting all strata of society and its members.
Social work practice has a responsibility to adequately support the chosen lifestyle of unpaid carers as their efforts form an invaluable service which saves the economy £132 billion per year (Carers UK, 2015a). Without the thousands of carers, the health of many of society’s most vulnerable would suffer as the government would struggle to fund the costs of providing alternative care. Yet there is a growing reliance upon unpaid carers who are willing and able to provide the care which allows people to remain within their home. Firstly, the health issues of an aging and unhealthy population means there are increasing numbers of people aged 18+ who find it difficult to look after themselves. Secondly, there is an expectation that unpaid carers
The National Cancer Institute articulates the importance of this support to a cancer patient, suggesting, “that having good information and support services can make it easier to cope,” adding, “friends and relatives can be very supportive,” and concluding with the usefulness of support groups (NCI website www.nci.nih.gov).... ... middle of paper ... ... York: Random House, 1991.
(Davidson, F. G.) Due to the nature of dementia being a neuropsychological disorder, those affected by the disease tend to look like they will not require much care, which, in reality, they often require more care than the caregiver originally expected, leading to stress and burnout. Another effect caused by this can be the caregiver blaming themselves by feeling like they are failing to give proper care, which, in reality, can often be very far from the truth. If the caregiver does not receive help from anyone else, the task of watching over the victim becomes a daunting twenty for hour task. Sometimes, the caregiver won’t be allowed quality sleep. Over 66 percent of home caregivers suffer from some form of psychological or physical illness. The most common illness that is resulted from giving care to Alzheimer’s disease is depression. The caregiver needs to monitor their emotional well-being as well as the well-being as the person that they are giving care to. Usually, giving care to those with dementia is actually more stressful than giving care to those with cancer. When the caregiver is a family member and not a professional, the emotional toll is often even greater. It is important for caregivers to remember that they need to take care of themselves first and
...if the caregiver needs a break. Also, talking to the family about friends and family that they have reached out too, or organizations that they are currently using to make everyday tasks easier. In general, the evaluation is going to be based off observation, and the family and patients verbal report of their well being.
However, this type of care brings a lot of unconditioned difficulties due to the constant care they have to provide the elderly people with dementia. In a recent study it was discovered that caregivers experience stress differently given the circumstance this was shown by analysis of 234 people with dementia (Robertson, Zarit, Duncan, Rovine, & Femia, 2007). The findings were that caregivers in intense and distressed groups experienced higher behaviora...
Green, P. (1984). The pivotal role of the nurse in hospice care. CA: A Cancer Journal for Clinicians, 34(4), 204-205.
Primary caregivers are given an opportunity to take care of their loved ones; however, this job comes with a lot of stress and its consequences (Tsai, 2003). Primary caregivers take care of those with a chronic illness such as a family member or friend, are given a task that is so immense that it induces a lot of stress. In the previous decades, many research articles have developed studies which focused on stressors that were associated with the task of being the primary caregiver; yet, a theory surrounding this topic has not been developed until the early 2000s. Tsai (2003) developed the Theory of Caregiver Stress based on the Roy Adaptation Model to identify the caregiver’s response, perceptions, and adaptations to the stress and burden that primary caregiver’s experience.
-Sonnenberg, E. 2008.Caregiver Stress: The Impact of Chronic Disease on the Family. Available at: http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=74397.Access date 21 December 2013.
Twice a day, an email full of support, encouragement, and information arrives in the inboxes of the 370 members of the Long-term Cancer Survivors mailing list. The topic of discussion is often the “late effects” of cancer treatment.
In the nursing profession, one of the primary responsibilities over a nurse is to provide care. A caregiver is “a person who provides direct care (as for children, elderly people, or the chro...
The Theory of Caregiver Stress was a significant breakthrough for the reasoning of why caregivers are so deeply affected by this job. “The Theory of Caregiver Stress was derived from the Roy Adaptation Model to use as basis in understanding the relationships among caregivers and the stress faced when caring for a chronically ill relative” (Tsai, 2003). The Theory of Caregiver stress is a middle-range theory used to predict the outcome for stress and other various side effects (Dobratz, 2011). These adverse effects are predicted by: Demographic Characteristics, Burden in Caregiving, Stressful life events, Social Support and Social Roles. Also, because of the multitude of different scenarios and background for both the patient and the caregiver, these categories are necessary to compare and effectively use the results. The theory makes four main assumptions regarding adaption: “environmental change; the caregivers’ perceptions will determine how they will respond to the environmental stimuli; the caregivers’ adaptation is a function of their environmental stimuli and adaptation level, and lastly the caregivers’ effectors are results of chronic caregiving such examples include marital satisfaction and self-...
Rationale: Therapeutic use of self by the nurse and concrete task definition and assignment reinforce positive coping strategies and allow caregivers to feel less guilty when tasks are delegated to multiple caregivers. Ackley and Ladwig p. 286
If warranted I think financial aid should be given to informal caregivers. However there should be strict guidelines to who can collect support for being an informal caregiver. The key being primary informal caregiver, Aunt Sue watching grandma a few hours a week shouldn’t qualify for assistance. There can be only one primary caregiver. The primary informal caregiver should provide 80% of the financial needs and live with the dependent 90% of the time. As stated by Moody long-term health care can be quite expensive and a staggering 70% of those placed into nursing facilities end up spending their life savings just to reside in a nursing home. But, it doesn’t end there, the family members of nursing home residence can be affected as well. Families
referred to as the recipient of care, this statement lacks true meaning; reducing person to a single machine-like object. They are first and foremost human beings whose care involves the whole individual. They exist within a matrix of family, caregivers, significant others, and communities. In my practice, human-centered care is central to the articulation of my personal nursing philosophy. It is one that treats the patient as an integrated individual of body, soul, and spirit, instead of simply treating their illness or health concerns in isolation. It requires me to stand in their shoes in order to convey an understanding of their situation. As such, they should not be reduced to simply generalizations, but should be cared for in their