Development of a home-based family caregiver cancer education program

INTRODUCTION: This article describes a home-based educational program developed specifically for family caregivers of cancer patients who receive hospice and home care. The overall aim of this educational program is to specifically address family caregivers' needs for acquisition of necessary knowledge and skills to meet the physical and psychosocial demands associated with caring for a patient with advanced cancer. PROGRAM DEVELOPMENT: Originally, components of this program were offered in a small group discussion format within hospital and community settings. The educational program was transformed to accommodate the unique needs and constraints of homebound family caregivers who have very limited time and/or opportunities for support and education outside of the home. The program is comprised of educational modules that provide hospice and home care professionals with written and audiovisual materials designed to facilitate brief, structured, educational encounters with family caregivers in the home setting. DISCUSSION: Two hundred thirty-seven educational module kits were distributed to professionals affiliated with twenty-four home care and hospice agencies in the Greater Philadelphia area. Results of a telephone survey designed to elicit evaluation data from professional staff members who had used the educational modules are presented. Limitations, plans for future program evaluation, cost implications, and implementation recommendations related to this educational program are described.     

Parenting preemies: a unique program for family support and education after NICU discharge

Research supports the importance of family-centered care in the neonatal intensive care unit (NICU). The significance of continuity in family-centered care beyond the NICU has recently gained attention. Parenting Preemies is a unique and easily replicated postdischarge program designed to ease the transition from hospital to home for NICU graduates and their families. The comprehensive program provides an effective means to demonstrate ongoing, family-centered, and cost-effective outreach after discharge. The specific target population includes premature, low birth-weight, and special needs infants, and their parents. A multidisciplinary team utilizes evidenced-based principles to facilitate an education and support group, in conjunction with home visits, as the foundation for promotion of optimal outcomes for preemies and their parents. Participant satisfaction is consistently positive.     

Development of a stroke family support and education program

An interdisciplinary stroke family support and education program can provide families with basic information about stroke and rehabilitation in addition to providing support to families as they adapt to the crisis of stroke. The theoretical basis for such a program is discussed in this article as well as program development, implementation and evaluation. Included are program goals, content outlines and a referral process.     

家庭教育前后精神分裂症病人家庭支持和自理行为的研究

目的探讨家庭教育对精神分裂症病人家庭支持和自理行为作用的可行性、有效性.方法将精神分裂症病人随机分为两组,对观察组家属实施家庭教育,为期4周,随访1年,采用家庭关怀指数问卷(Family APGAR index)和自理行为问卷(Self-Care Behavior Questionnaire,SCBQ)对病人进行评定.结果观察组精神分裂症病人得到较多的家庭支持,从而执行较多的自理行为,与对照组比较差异有显著意义(P<0.01),家庭支持和自理行为间存在正相关(r=0.26,P<0.05).结论家庭教育有利于指导家属向病人提供有效的家庭支持,促进病人自理.     

Gait characteristics of individuals with multiple sclerosis before and after a 6-month aerobic training program

Individuals who have multiple sclerosis (MS) typically experience problems with physical activities such as walking, resulting from the combined effects of skeletal muscle weakness, sensory disturbances, spasticity, gait ataxia, and reduction in aerobic capacity. The aim of this study was to determine whether a 6-mo exercise program designed for aerobic conditioning might also affect gait abnormalities in individuals with MS. Subjects included 18 individuals with MS who presented a range of disability. Passive range of motion (PROM) in the lower limbs was measured and gait analyzed before and after exercise conditioning. Three-dimensional kinematics, ground reaction forces (GRF), and electromyographic information were acquired as subjects walked at self-selected velocities. Hip PROM increased following conditioning. Mean walking velocity, cadence, and posterior shear GRF (push-off force) decreased. During walking, maximum ankle dorsiflexion decreased and ankle plantarflexion increased. Total knee flexion/extension range during the walking cycle decreased slightly as did maximum hip extension. Results suggest this 6-mo training program had minimal effect on gait abnormalities.     

Touch, Caring, and Cancer: randomized controlled trial of a multimedia caregiver education program

Purpose

A randomized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home.

Methods

A multilingual 78-min DVD and 66-page manual were produced for homebased instruction. Content addresses attitudes and communication about touch in cancer, psychological preparation for giving and receiving touch, safety precautions, massage techniques for comfort and relaxation, acupressure for specific cancer-related symptoms, and practice in the home setting. Materials were produced in English, Spanish, and Chinese versions. A community-based multiethnic sample of 97 adult patient/caregiver dyads was randomized to experimental (massage) or attention control (reading) groups for 4 weeks. Massage dyads received the program and instructions to practice at least three times per week, while control caregivers read to their patients for the same frequency. Self-report instruments assessed change in symptom severity, quality of life, perceived stress, and caregiver attitudes.

Results

Significant reductions in all symptoms occurred for patients after both activities: 12–28 % reductions after reading vs. 29–44 % after massage. Massage caregivers showed significant gains in confidence, comfort, and self-efficacy using touch and massage as forms of caregiving.

Conclusions

Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain, depression, and other symptoms. Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress.     

Loss of lifestyle: health behaviour and weight changes after becoming a caregiver of a family member diagnosed with ovarian cancer

Purpose  

Little is known about how caring for someone affects the caregiver's health behaviours. We explore behaviour changes and their determinants in caregivers of women with ovarian cancer.     

Patient and caregiver outcomes 12 months after home-based therapy for hip fracture: a randomized controlled trial

OBJECTIVE: To compare the effect of early discharge and home-based therapy with conventional hospital rehabilitation on patient and caregiver outcomes at 12 months after hip fracture. DESIGN: Randomized controlled trial. SETTING: Acute and subacute care with follow-up in a community setting in Australia. PARTICIPANTS: Sixty-six older adults admitted to acute care after hip fracture who were assessed as needing rehabilitation. INTERVENTIONS: Eligible patients were randomized to either home-based (n=34) or hospital (n=32) rehabilitation. Patients assigned to the home-based group were discharged home within 48 hours of randomization. Patients assigned to hospital rehabilitation received usual care. MAIN OUTCOME MEASURES: Modified Barthel Index (MBI), timed up and go (TUG) test, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index. RESULTS: At 12 months, 56 of 66 (85%) participants were available for follow-up assessment. Both groups achieved significant improvements in MBI and TUG test scores. Patients in both groups had a significant decline in the physical score of the SF-36 and there were no differences between groups. Caregivers of patients allocated to receive home-based therapy reported a reduction in burden after 12 months. Over that period, there was a significant reduction in the burden for caregivers of those patients who received home rehabilitation (P=.020). CONCLUSION: For patients who were previously functionally independent and living in the community, early return home with increased involvement of caregivers after hip fracture resulted in similar patient outcomes (home vs hospital) and less caregiver burden at 12 months.     

Symptom severity 1 to 4 months after thoracotomy for lung cancer

BACKGROUND: Information about the severity of symptoms during recovery from surgery for lung cancer can be useful in planning and anticipating needs for recovery. OBJECTIVES: To describe symptom severity during the first 4 months after thoracotomy for non-small cell lung cancer and factors associated with overall symptom severity at 1 and 4 months. METHODS: Ninety-four patients were assessed at 1, 2, and 4 months after thoracotomy by using the Lung Cancer Symptom Scale, Brief Pain Inventory, Schwartz Fatigue Scale, Dyspnea Index, and Center for Epidemiology Studies-Depression Scale (CES-D). Clinically meaningful changes, decrease in the proportion of patients with severe symptoms, and relationships among symptoms were determined. Mixed effects models for repeated measures were used to evaluate changes in severity. Multiple regression models were used to examine correlates of overall symptoms. RESULTS: Mean symptom severity significantly decreased over time for most symptoms. Only disrupted appetite, pain, and dyspnea had clinically meaningful improvement at 4 months. Severe symptoms included fatigue (57%), dyspnea (49%), cough (29%), and pain (20%). Prevalence of depressed mood decreased at 4 months. Most patients (77%) had comorbid conditions. Number of comorbid conditions and CES-D explained 54% of the variance in symptom severity at 1 month; comorbid conditions, male sex, neoadjuvant treatment, and CES-D score explained 50% of the variance at 4 months. CONCLUSIONS: Severe symptoms continued 4 months after surgery for some patients, indicating the need for support during recovery, especially for patients with multiple comorbid conditions and depressed mood.     

Long-term effectiveness of a patient and family pain education program on overcoming barriers to management of cancer pain

The purpose of this research was to investigate the effectiveness of a patient and family pain education program on reducing cancer patients' and their families' barriers to (i.e., concerns or misconceptions about) cancer pain management, on increasing patients' adherence to a prescribed analgesic regimen, and on decreasing pain intensity and pain interference with daily life. An experimental and longitudinal design was used. The experimental group consisted of 31 pairs of cancer outpatients and their family carers, while the control group consisted of 30 patient-family pairs (N=122). Patients and their family carers in the experimental group simultaneously received a pain management education program. Both groups had pretest data collection and after-test follow-ups on the second and fourth weeks at the outpatient clinics. Comparisons between those two groups were made using the Generalized Estimating Equations (GEE) method. Results revealed that at both the second and fourth weeks, patients and family carers in the experimental group showed a significantly greater reduction in barrier scores than did patients and family carers in the control group. At the second and fourth weeks, patients in the experimental group reported significantly better adherence to a scheduled analgesic regimen than did patients in the control group. In the fourth week, patients in the experimental group reported significantly lower levels of worst pain intensity and pain interference than did patients in the control group. This research provides evidence of the effectiveness of a patient and family pain education program.     

Caregiver characteristics predict stroke survivor quality of life at 4 months and 1 year

Evaluating factors that reduce stroke survivors' (SS) health‐related quality of life (HRQOL) is important for developing interventions to improve HRQOL after stroke. The influence of baseline caregiver and family characteristics (physical health, depressive symptoms, family communication) on five domains of SS HRQOL (physical function, memory/thinking, social activities, communication, and mood) was examined. Data were collected on 132 SS‐caregiver dyads at baseline, 4 months, and 12 months. Baseline caregiver depressive symptoms predicted lower scores for SS physical function and communication at 4 months and social participation and mood at 12 months. Male caregiver gender was negatively associated with SS HRQOL (communication and mood) at 12 months. Early intervention targeting these family characteristics, especially caregiver depressive symptoms, may improve survivors' HRQOL. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:592–605, 2009     

癌症患者化疗前与化疗中心理特征与护理

癌症是当今世界上对人类健康与生命危害最大的疾病之一,其发病率和死亡率在世界上许多国家呈急剧增长的趋势[1]。化学治疗(简称化疗)是一种重要的癌症治疗方法,常伴有不同程度的不良反应和脏器的损伤[2]。癌症本身及化疗的副作用使得癌症化疗患者存在严重的心理问题,影响着患者的身心健康。本文探讨化疗前及化疗中80例患者的心理特征与反应,并针对性地提出相应的心理护理措施,以期改善癌症化疗患者的心理健康,减轻患者痛苦,提高生命质量。现报道如下。1资料与方法1.1临床资料选择2009年3～12月入住我院的80例癌症确诊患者,男45例,女35例。年龄21～81岁。肺癌21例,肝癌20例,直肠癌18例,胃癌10例