Psychometric testing of the revised 15-item Bakas Caregiving Outcomes Scale

BACKGROUND: Family caregivers of stroke survivors experience a variety of negative social, emotional, and health-related outcomes as a result of providing care. OBJECTIVES:: To psychometrically test the revised 15-item Bakas Caregiving Outcomes Scale (BCOS) measuring life changes specifically resulting from providing care. The original 10-item BCOS was improved by adding five items addressing financial well-being, level of energy, role functioning, physical functioning, and general health. METHODS: Psychometric testing of the revised 15-item BCOS using a sample of 147 family caregivers of stroke survivors approximately 4 months after stroke was conducted to determine the quality of the items, internal consistency reliability, test-retest reliability, construct validity, and criterion-related validity. Most caregivers were women (78.9%), White (68.0%) or African American (29.9%), and either spouses (60.1%) or adult children (31.3%). RESULTS: Satisfactory evidence of internal consistency (alpha = .90) and 2-week test-retest reliability (intraclass coefficient [ICC] = .66; 95% confidence interval [CI] = 0.42-0.81) was provided, with item-to-total correlations ranging from .41 to .74. Unidimensionality was supported by confirmatory factor analysis with indices, indicating a good fit. Using hierarchical multiple regression, 36% of the BCOS variance was explained by constructs in the conceptual model [F(11,132) = 6.72, p < .001]. Criterion-related validity was supported by correlations with the 36-item Short Form (SF-36) General Health Subscale (r = .32, p < .001) and a criterion variable measuring how caregivers' lives had changed overall (r = .67, p < .001). DISCUSSION: The revised 15-item BCOS has evidence of satisfactory reliability and validity in family caregivers of stroke survivors. The BCOS is a valuable measure in research and can be used to identify priority areas for nursing interventions designed to improve caregivers' outcomes.     

Development and psychometric testing of the Bakas Caregiving Outcomes Scale.

BACKGROUND: Family caregivers of stroke survivors experience more depression, emotional problems, social inactivity, and general ill-health than noncaregiving individuals. While a number of instruments measure these variables in family caregivers, they are often too global, indicating the need for a situation-specific instrument measuring life changes resulting from providing care. OBJECTIVES: To develop and psychometrically test the Bakas Caregiving Outcomes Scale (BCOS) measuring changes in family caregiving outcomes in the stroke population. METHOD: 48 items were developed, with 27 being judged as content valid by a panel of five experts. Psychometric testing with two convenience samples of family caregivers of stroke survivors (ns = 92, 104) was conducted using item analysis, Cronbach's alpha, factor analysis, and hierarchical multiple regression. RESULTS: Item analysis in sample no. 1 resulted in a 12-item scale with alpha = .90. The scale was further shortened to a 10-item scale in sample no. 2 with alpha = .77. Unidimensionality was supported by factor analysis in both samples. Using hierarchical multiple regression, 63% of the variance of the 12-item BCOS in sample no. 1, and 45% of the variance of the 10-item BCOS in sample no. 2 was accounted for by the constructs in the conceptual model. Criterion-related validity was supported in both samples by significant correlations with the LIFE-3 and a criterion variable with the same response format as the BCOS. Significant BCOS correlations with the SF-36 Health Survey subscales in sample no. 2 provided further evidence of criterion-related validity. CONCLUSION: The 10-item BCOS is a brief, easy to administer instrument that has evidence of reliability and validity in family caregivers of stroke survivors. The 10-item BCOS could serve as a valuable measure in research, as well as an assessment tool to identify family caregivers in need of intervention.     

上海市晚期癌症患者居家姑息照护服务内容研究

目的 确定上海市晚期癌症患者居家姑息照护服务的内容及项目.方法 采用Delphi法对15名专家进行2轮咨询.结果 2轮专家咨询的应答率均为100%,专家的权威程度0.864,变异系数<50%的指标占84%,肯德尔和谐系数统计协调性在必要性、技术可行性、人力可行性及风险性方面具有统计学意义(P<0.000).形成了由4项一级指标、26项二级指标、21项三级指标组成的晚期癌症患者居家姑息照护服务内容.结论 专家合作程度及权威程度高,专家意见协调性较好,所形成的服务内容有一定的预测意义和可操作性,但要纳入社区卫生政策,该服务内容仍需在社区进一步验证和完善.     

Sleep disturbance in family caregivers of patients with advanced cancer

Sleep is a complex process known to be essential for health, well-being, and optimal physical and psychological functioning. Therefore, sleep disturbance may lead to serious consequences. Advanced cancer patients are known to experience a complex constellation of symptoms requiring round-the-clock care. This reality, coupled with the current demographic, social, economic and health policy trends which are shifting palliative care from the hospital to the community setting, will see family members increasingly assuming responsibility for the provision of this care at home. Despite the positive aspects of caregiving, studies report that families experience stress and exhaustion. Given that patient and family constitute the unit of care in palliative care, this area warrants our attention. This article reviews the literature related to family caregivers' disturbed sleep while caring for someone with advanced cancer. What is known and directions for future research will be addressed.     

Management of infections in palliative care patients with advanced cancer

To characterize infections and their management in oncology patients at the end of life, we conducted a review of the literature. Eight studies assessing infection in 957 patients with various malignancies were identified. Forty-two percent of terminally ill patients developed infections in the final phase of care. The greatest frequency of treatment with antibiotics occurred in acute care hospitals. Enterobacteriaceae and S. aureus were the most frequently isolated bacteria, and urinary and respiratory tracts the most frequently involved sites of infection. A total of 19-39% of individuals with suspected infection and advanced cancer died. The decision whether to treat or not in the palliative care setting may be complex and requires an individualized approach. Further research in this area will help develop a consensus for management that will facilitate education of students and residents regarding complex decisions of care of infections at the end of life.     

晚期消化道肿瘤患者家庭主要照顾者对缓和医疗认知及态度的调查分析

目的 探讨晚期消化道肿瘤患者家庭主要照顾者对缓和医疗的认知及态度,并分析两者的影响因素。 方法 选取2018年7月-2019年7月在我院消化科住院的150例晚期消化道肿瘤患者的家庭主要照顾者为研究对象,采用缓和医疗需求度问卷对其进行调查,了解其对缓和医疗的认知和态度。 结果 晚期消化道肿瘤患者家庭主要照顾者对缓和医疗的认知率为51.33%,呈偏低状态;对缓和医疗的需求率为79.33%;Logistic回归分析结果显示,照顾者年龄、文化程度、家庭人均月收入、职业和患者年龄5个因素是家庭主要照顾者对缓和医疗认知和态度的独立影响因素。 结论 晚期消化道肿瘤患者家庭主要照顾者对缓和医疗缺乏认知,但需求度较高。这提示我们要做好缓和医疗知识的宣传工作,尤其要做好低收入、低学历人群的干预工作,促进缓和医疗的应用,以提升患者生存质量。     

Predictors of self-care in cancer patients receiving radiotherapy

The purpose of this study was to examine, within a theoretical framework derived from Orem's conceptual model of nursing, whether self-care can be predicted jointly by social support and the selected basic conditioning factors of age, marital and socioeconomic status, living arrangements, and stage and site of cancer. A convenience sample of 112 adult cervical and head/neck cancer patients receiving radiotherapy was obtained from radiotherapy outpatient clinics in three hospitals located in Bangkok, Thailand. Multiple regression was used to analyze the data. Socioeconomic status and social support were significant predictors of self-care, whereas stage and site of cancer seemed to predict self-care indirectly through social support. The findings are discussed in terms of the validity of Orem's self-care model. Implications for practice and further study are explored.     

The palliative prognostic score and survival in patients with advanced solid tumors receiving chemotherapy

Purpose To evaluate the accuracy of the Palliative Prognostic Score (PaP score) in selecting metastatic gastrointestinal or nonsmall-cell lung cancer patients candidate to palliative chemotherapy. Materials and methods The PaP score was calculated in 173 patients with advanced, pretreated gastrointestinal or nonsmall-cell lung cancer before starting a further line of chemotherapy with palliative aim. Symptom distress score was calculated using the Edmonton Symptom Assessment System (ESAS) before every course of chemotherapy. Univariate analysis of survival was performed using the logrank test; multivariate analysis was performed using the Cox regression model. Symptom distress scores were compared using multivariate analysis of variance test for repeated measures, and overall symptom distress score was compared using analysis of variance test for repeated measures. Results Overall median survival was 26 weeks; in PaP score class A it was 32 weeks, and in class B 8 weeks (p < 0.0001). No patient was classified in class C. The two-class PaP score resulted in an independent prognostic factor (p = 0.022), as well as Karnofsky performance status (p = 0.002) and colorectal cancer (p = 0.017). A trend towards worsening of symptom distress was observed in the entire population and in class A. The high number of missed data did not permit an adequate analysis in class B. Conclusions The PaP score seems to discriminate patients who could benefit by palliative chemotherapy from those who could better benefit by supportive and palliative approach. However, the data are insufficient to validate the use of the PaP score in patients to be treated with palliative chemotherapy, and further trials should be planned to assess its ability to improve the quality of care in oncology and the appropriateness in the choice of palliative chemotherapy.     

姑息性放疗联合阿帕替尼治疗晚期肺癌的近期疗效与安全性

目的 观察晚期肺癌患者接受姑息性放疗联合阿帕替尼治疗的临床近期疗效及安全性.方法 回顾性分析40例晚期肺癌患者的临床资料,按照治疗方法的不同将患者分为对照组和观察组,每组20例.对照组患者单纯接受姑息性放疗,观察组患者在此基础上联用阿帕替尼治疗.比较治疗后2组的临床近期总有效率、临床症状评分和毒副反应发生率.结果 观察...     

Psychometric properties of the brief fatigue inventory in Greek patients with advanced cancer

To validate the Greek version of the Brief Fatigue Inventory (BFI-Gr) in a sample of cancer patients, the scale was translated with the "forward-backward" procedure to Greek. It was administered twice, at a three-day interval, to 102 eligible patients with cancer. Together with the BFI-Gr scale, the patients also completed the European Organization for Research and Treatment of Cancer QLQ-C30 (version 3.0) subscales of fatigue and emotional functioning, and the M. D. Anderson Symptom Inventory. The BFI-Gr had an overall Cronbach alpha for the nine items of 0.954. The assessment of the relationships between the BFI-Gr and the other measurements showed statistically significant correlations between all the assessed measurements (r values between 0.47 and 0.76, P<0.0005), except with the emotional subscale of the European Organization for Research and Treatment of Cancer scale. Factor analysis yielded a one-factor solution, explaining 73.6% of the variance. Interitem correlations were high and ranged from 0.567 to 0.882 (P<0.0005). The test-retest reliability of scale showed that the coefficient agreement was 0.901 (P<0.0005). Univariate analysis revealed significant correlations between hemoglobin and fatigue (r=-0.21, P=0.037), and between performance status (P<0.0005) and opioids (P=0.009). These results support that the BFI-Gr is an instrument with satisfactory psychometric properties, and is a valid research tool for cancer-related fatigue in Greek cancer patients.     

Antimicrobial use in patients with advanced cancer receiving hospice care

Patients with advanced cancer receiving hospice and palliative care are highly susceptible to infections. The decision whether to treat an active or suspected infection in end-of-life care may be difficult. In order to develop guidelines for the use of antimicrobials (antibiotics and antifungals) in palliative care, we discussed antimicrobial options with 255 patients with advanced cancer at the time they entered a community-based hospice and palliative care program. We subsequently documented the use and effectiveness of the antimicrobials employed during the palliative care period. Most patients (79.2%) chose either no antimicrobials or symptomatic use only. Choices were influenced by age, the desire for symptom control, life-prolongation issues, and the condition of the patient. After admission, 117 patients had a total of 129 infections, with the most common sites being urinary tract, respiratory tract, mouth/pharynx, and skin/subcutaneous tissues. The use of antimicrobials controlled symptoms in the majority of the urinary tract infections, but were less effective in controlling symptoms in the other sites of infection. Survival was not affected by the patients' choice of whether to use antimicrobials, the prevalence of infections, or the actual use of antimicrobials. Symptom control may be the major indication for antimicrobial use for patients receiving hospice and palliative care.     

Quality of life of patients with terminal cancer receiving palliative home care

The purpose of this study was to determine the levels of quality of life of patients with terminal cancer who received palliative care in home settings. Data were collected from 85 cancer patients with a life expectancy of less than 12 months using the McGill Quality of Life Questionnaire-Hong Kong version (MQOL-HK). The mean total quality of life score was 6.36 +/- 1.37 out of 10. Among the various domains, the physical and existential domains scored relatively low with mean scores of 4.9 +/- 1.28 and 6.12 +/- 1.6 out of 10, respectively. Conversely, the subscales of sexual functioning and support yielded the highest scores with mean values of 7.45 +/- 4 and 6.8 +/- 1.9, respectively. There was a significant moderate correlation between age and the mean total quality of life scores (r = 0.53, p < 0.01). In addition, a moderate negative correlation was found between pain intensity and physical subscale (r = -0.57, p < 0.01). In conclusion, patients with terminal cancer receiving palliative home care experienced a moderately high level of quality of life, especially in the sphere of support.