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Biomedical subjects

B A Given

Publications and source records attributed to B A Given.

At least 19 recordsLinked to original sources
PubMed2001

Improving depressive symptoms among caregivers of patients with cancer: results of a randomized clinical trial.

PURPOSE/OBJECTIVES: Determine the impact of a 16-week supportive nursing intervention on caregivers of patients with newly diagnosed cancer. DESIGN: Randomized clinical trial. SETTING: Two midwestern cancer treatment sites. SAMPLE: Caregivers of newly diagnosed patients. Patients' mean age was 55.73 years; 55% had breast cancer, and 76% were female. Caregivers' mean age was 52.44 years, and 50% were female. 125 dyads consented to participate; 89 dyads completed the study. METHODS: A nursing intervention was delivered to the experimental group that emphasized symptom monitoring/management, education, emotional support, coordination of services, and caregiver preparation to care. Nurses made a total of nine contacts, five in person and four by telephone, over 16 weeks. Centers for Epidemiological Studies-Depression (CES-D) and a symptom inventory were used. Medical record audits were conducted retrospectively. MAIN RESEARCH VARIABLES: Patient and caregiver depression scores and patient symptom experience. FINDINGS: Baseline caregiver depression and the number of patient symptoms at baseline, 9, and 24 weeks were significant predictors of caregiver depression at 9 and 24 weeks. However, no main effect of the experimental condition existed on caregiver depression. At the final observation, a nonsignificant inverse relationship was found between the number of interventions and depression scores for caregivers. CONCLUSIONS: The intervention appeared to be more effective in slowing the rate of deterioration of depressive symptoms than in decreasing levels of depression in this sample of caregivers. Determining the effectiveness of this intervention in decreasing caregiver depression was difficult because caregivers with higher levels of depression were more likely to withdraw from the study. IMPLICATIONS FOR NURSING PRACTICE: Nurses must be vigilant in monitoring caregivers for signs of depression and must intervene to provide emotional support and make appropriate referrals for follow-up care to promote positive outcomes for patients and caregivers.

Analysis of Variance↗
PubMed2000

Symptomatology and loss of physical functioning among geriatric patients with lung cancer.

In this study of 129 geriatric patients with lung cancer, we investigated how symptom severity varied according to treatment type, stage of disease, and gender; how change in physical functioning (prediagnosis versus post-hospital discharge) was predicted by symptomatology, prior physical functioning, comorbidity, and age; and whether differences exist according to stage of disease, treatment status, or gender. Data were gathered through patient interviews and audits of patient records. Analysis of variance (ANOVA) techniques revealed that there were no significant differences in average symptom severity scores by gender, treatment categories, or stages of disease. Significant predictors of loss of physical functioning were symptom severity, prior physical functioning and patient age. Characteristics of a profile for elderly lung cancer patients at high risk of suffering substantial losses in physical functioning include higher prior levels of physical functioning, higher levels of current symptomatology, and lower age.

Activities of Daily Living↗
PubMed1999

The impact of new demands for assistance on caregiver depression: tests using an inception cohort.

Family caregivers of patients facing high numbers of new demands for assistance following hospital discharge were more likely to experience increased levels of depression in the following six months compared with caregivers facing similar overall demands but few new demands for assistance following hospital discharge. New demands for assistance had a significant independent effect upon the levels of depression and were independent of family relationship (spouse vs nonspouse) and caregiver gender. These findings provide insight into theories of caregiver stress, begin to specify the interaction of time following the onset of a stressful event and caregivers' subsequent reactions, and suggest which caregivers may require some assistance following discharge of their patients.

Aged↗
PubMed1999

A profile of bereaved caregivers following provision of terminal care.

Caregivers are often overwhelmed by the strain of terminal caregiving. We wished to better understand the needs of terminal caregivers and to supply a basis for tailoring interventions to them during caregiving and early bereavement. This report provides a profile of 124 bereaved caregivers interviewed within three months of their patient's death. Three quarters were female and married to the patient. Four major areas were assessed: psycho-spiritual, personal-social, health status, and financial status. Caregivers reported higher than average depressive symptomatology (mean CES-D = 17.6), moderate levels of positive outlook, low negative reactions to caring, and relatively high levels of spirituality. Caregivers were highly involved in their patient's activities of daily living, providing an average of 10.8 hours/day of direct care and 8.9 hours/day of companionship. Caregivers reported low utilization of health services and relatively high personal health status. 45% of the sample reported lower income since the patient's death and 44% reported out-of-pocket expenses not covered by insurance. Suggestions for interventions that target emotional, physical, and financial concerns are discussed.

Adult↗
PubMed1998

Health promotion for family caregivers of chronically ill elders.

Previous research has focused almost exclusively on the burden and the negative effects of caregiving on the primary caregivers of the chronically ill. This prior research has provided a backdrop for understanding the psychological and physical challenges that caregiving incurs. Missing from past research, however, is any focus on the health promotion strategies of this caregiving population. Although some literature focuses on the psychological well-being, few articles deal with the physical health status of caregivers. Fewer yet describe the health promotion strategies that caregivers use to maintain their health. The chapter reviews existing literature regarding health promotion activities of primary caregivers in the context of articles focused on the psychological and physical health status of caregivers. Health promotion strategies will be discussed, as will recommendations for future research in this topic area.

Aged↗
PubMed1996

The advanced practice nurse: meeting the information needs of the rural cancer patient.

BACKGROUND: The goal of the Rural Cancer Care Project is to assist patients and families residing in rural areas to receive the highest-quality cancer care in their own communities. METHODS: An advanced practice nursing clinic, serving as an adjunct service to specialty cancer care, is the core of the intervention model demonstrated by the "Rural Partnership Linkage for Cancer Care", a National Cancer Institute grant awarded to Michigan State University in 1990. The nursing intervention is directed to meeting patient and family needs. RESULTS: One hundred seventy patients enrolled in the study beginning in January 1993 through September 1995. Knowledge deficit proved to be one of the most frequently identified problems (in 78% of the 170 patients evaluated), although the patient and family had often received care at a community oncology center with specialist health care professionals. Teaching was a major nursing intervention employed in patient care to address patient problems and needs as presented (e.g., chronic pain, fatigue). The data also demonstrated that the patients had more knowledge needs in the later stages of disease when they had cancers in all sites but the breast, where patients with Stage I and II disease had the greater learning needs. CONCLUSIONS: Nursing interventions were directed primarily at education regarding cancer as a disease or the understanding of chemotherapy. The advanced practice nurse, by providing direct patient and family education in a community setting, does improve patient knowledge and subsequent outcomes.

Ambulatory Care Facilities↗
PubMed1996

Establishing a collaborative practice in a comprehensive breast clinic.

BREAST CANCER IN women is a major health concern due to the high prevalence of subtle changes in breast tissue that are difficult to diagnose. Consequently, women require information about benign and malignant breast changes. Nurse practitioners (NPs) can play an important role in helping women with breast concerns by incorporating clinical expertise with teaching and counseling skills. Establishing clinics in which information, screening, and diagnosis of breast cancer are readily available will help decrease women's anxiety and enhance their ability to act as self-advocates within the healthcare system. A comprehensive breast clinic was developed, incorporating NP and physicians in a collaborative model of care. Defining roles within the model was an ongoing process as each provider developed areas of expertise and interest. The NP role emerged as an integral part of the practice, increasing the efficiency, availability, and effectiveness of clinic services.

Breast Neoplasms↗
PubMed1996

Breast cancer screening in rural populations: a pilot study.

This report describes the development and implementation of a pilot intervention project designed to determine the economic, logistic, behavioral, and attitudinal variables that influence rural women's participation in a community-based breast cancer screening program. This paper reports on survey responses of women who registered for this pilot breast cancer screening program. It includes information on all women who registered for the project--both those who received breast cancer screening and those who did not. The study is a pilot intervention project, the overall goal of which was to develop a network of community providers, organizations, and volunteers to facilitate breast cancer screening among rural women. Of the 159 women registered for this pilot program, 101 (63.5%) were screened (receiving both a clinical breast examination and mammogram). The attitudes of women surveyed through the project confirm the importance of a physician recommendation for breast cancer screening. More than 90 percent of both the screened and unscreened groups of women stated that a doctor's recommendation to have breast cancer screening is important. Further, nearly 42 percent of the unscreened group had never had a physician recommend breast cancer screening. Despite existing barriers to screening, this pilot study demonstrated that health care professionals and regional organizations that have not traditionally been associated with delivering health care in this particular community setting can successfully work together to implement breast cancer screening programs.

Adult↗
PubMed1995

Parent caregivers: a comparison of employed and not employed daughters.

A major task for social workers is sorting out the kinds of assistance needed by families who care for an elderly parent. In particular, information is needed about the differential effects of employment on daughters who care for their elderly parent. This study describes parental caregiving among three groups: daughters who were employed, daughters who were never employed while caregivers, and daughters who ended their employment to continue caregiving. The effects of caregiving on these three groups, as well as the daughters' involvement with care tasks and use of formal and informal assistance, are examined.

Adult↗
PubMed1994

The impact of age, treatment, and symptoms on the physical and mental health of cancer patients. A longitudinal perspective.

BACKGROUND: To describe continuing care and rehabilitation needs of cancer patients, a longitudinal design (6 months) was performed among patients 50 years of age and older with solid tumors. The study examined how age, type of treatment, site of cancer, and symptom experience affect physical functioning and their mental health; age, site of cancer and the interval of time out of treatment influence changes in their symptom experience; and age, site of cancer, the interval of time out of treatment, and changes in symptom experience influence changes in physical and mental health. METHODS: Patients (n = 111) who completed an intake and a 6-month self-administered questionnaire were included. Treatment included chemotherapy, radiation, or hormonal treatment at intake and for 6 months. Scales of nine symptoms and physical health using activities of daily living and measures of vigorous function were composed. Mental health was measured by the Center for Epidemiological Studies--Depression Scale. RESULTS: The analyses yielded the following findings: (1) Primary site may have had an impact on symptom experience, limitations in functioning, and mental health if more patients with lung cancer had survived to 6 months. (2) Age, gender, treatment, or change in treatment had no impact on symptoms, functioning, or mental health at intake or changes in these variables. (3) Symptom experience at intake and the changes in symptoms predicted physical functioning and mental health at intake and the changes in these variables over time. (4) Gender differences were important in predicting mental health. CONCLUSIONS: Strategies for continuing care and rehabilitation need to focus on symptom management, and strategies need to be different for male and female patients.

Activities of Daily Living↗
PubMed1994

Strategies to meet the needs of the rural poor.

Demographic, geographic, and economic forces have influenced the treatment and supportive care of patients with cancer and their families who reside in rural areas. The trends that limit access to cancer care include an aging population, lower income, less comprehensive insurance coverage, ill-equipped and poorly staffed health care facilities, and geographic isolation from health care services. It is important to develop strategies that can be used to overcome the barriers to rural cancer care.

Clinical Competence↗
PubMed1994

The costs of family contributions to the care of persons with dementia.

This study focuses on the costs of dementia care incurred by families. Cost components operationalized include: costs of unpaid caregiver labor services, paid and unpaid family labor, paid and unpaid services of nonfamily persons, and cash outlays for equipment and services. Among 182 families of dementia patients, average care costs for a 3-month period amount to $4,564. Cash expenditures average only 29% of total care costs, with unpaid labor accounting for 71% of the family care costs. Total care costs rise by $1,158 for each additional dependency in an activity of daily living (ADL), while reliance on paid services is 5% higher for each additional $10,000 household income and drops by 25% if the patient lives in the caregiver's household.

Activities of Daily Living↗
PubMed1994

Predictors of use of secondary carers used by the elderly following hospital discharge.

This research examines how caregiver-patient relationship (female spouses, and adult daughters and daughters-in-law) when cross classified with patient coresidence patterns explains the level of secondary carers' involvement among patients with newly added needs for assistance at home following hospital discharge. Among 196 primary caregivers (104 spouses, 92 daughters and daughters-in-law), patient needs were divided into ADL and mobility limitations, and medical tasks. Secondary carer involvement was categorized into levels differing at two observations: one following discharge and a second 3 months later. Analyses focused on explaining the levels of involvement of secondary carers following hospital discharge and the changes in secondary carers' involvement between the two observations. The baseline and change analyses revealed that caregiver-patient relationship was more important than coresidence patterns or patients' demands in explaining assistance from secondary carers. The implications of these findings on caregivers' reactions and policies regarding home care are explored.

Aged↗
PubMed1994

Family home care for individuals with cancer.

Cancer care has, to a great extent, shifted to outpatient and home settings, placing more responsibility for such care on the family members. Home care encompasses a wide range of patient needs, including symptom management, monitoring and use of equipment, medical care tasks related to surgery, coordination of care, and monitoring and evaluation of key health status parameters, as well as assistance with self-care and instrumental activities. Different families organize care tasks in different ways. By understanding how a particular family responds and organizes to fulfill patient care needs, health-care professionals will have a basis upon which to construct a plan of care in partnership with the patient and family members. This article describes home care issues from the perspectives of the patient and family members, and proposes strategies that health-care professionals can use to improve the outcomes of supportive care for the patient and family.

Caregivers↗
PubMed1993

The cost of cancer home care to families.

BACKGROUND: For the most part, previous research on costs of cancer care has focused on the formal medical care costs. Research on home care for patients with cancer has emphasized direct care costs (expenditures). Among indirect costs, only loss of income to family members has been studied. However, a major component of indirect costs, the family labor expended to care for the patient with cancer, needs to be included for a more realistic appreciation of home care costs. METHODS: The costs of family labor are estimated by imputing monetary values for the time spent caring for the patient with cancer. The assigned monetary cost either is equated with income losses of the helper in question or is based on a putative market value of the expended labor time. In addition, out-of-pocket expenditures examined in this study cover all cancer care-related expenses for which the patient was not reimbursed by third parties. Data were obtained from a convenience sample of 192 patients with cancer and their families in lower Michigan. RESULTS: When family labor is included in the cost calculations, average cancer home care costs for a 3-month period ($4563) are not much lower than the costs of nursing home care. The substantial variation in home care costs (standard deviation [SD] = $4313) appears to be unrelated to the type of cancer diagnosis, type of treatment, or time since diagnosis but seems to be driven by the functional status of the patient and the family living arrangements. CONCLUSIONS: Outpatient care for patients with cancer coupled with greater reliance on home care appear to be economically attractive because costs to families usually are underestimated.

Adult↗
PubMed1993

Gender bias in the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D).

Confirmatory factor-analytic models are used to examine gender biases of individual items of the Center for Epidemiologic Studies Depression (CES-D) Scale. In samples containing 708 cancer patients and 504 caregivers of the chronically ill elderly, two CES-D items are identified as producing biased responses in comparisons of male and female respondents. Three additional CES-D items are excluded on the basis of other psychometric problems, yielding a subset of 15 CES-D items that capture almost all the information of the original 20-item CES-D scale but are free of any gender bias. Gender differences in mean levels of depressive symptomatology are significantly reduced, but not eliminated, when the 15-item scale is used.

Activities of Daily Living↗