Julia Hannum Rose

Relationship Quality and Burden among Caregivers for Late-stage Cancer Patients

ObjectiveThis study explores how caregiver relationship quality with family, patient, and patient’s health care provider (HCP) is associated with subjective caregiver burden during the early treatment phase for late-stage cancer.MethodBurden and relationship quality were assessed in telephone interviews with family caregivers (FCGs) of advanced cancer patients. The five subscales of the Caregiver Reaction Assessment measured burden, while relationships were measured with the Family Relationship Index, the Family Inventory of Needs subscale of met needs, and a scale assessing family discord in cancer communication.ResultsMultiple linear regression analyses in SPSS (v16) of 420 FCGs showed that higher quality relationship with family was associated with lower burden in FCG abandonment, health, scheduling (p < 0.001) and finances (p < 0.01). Higher quality relationship with patients’ HCPs was associated with lower burden in FCG abandonment (p < 0.05), health, and finances (p < 0.001). More discordant communication in patient relationship was associated with lower financial burden (p < 0.05). Relationship quality was not associated with caregiver self-esteem.ConclusionsFindings demonstrate that caregiver relationship quality with family and with HCP are important factors in understanding caregiver burden during the early treatment phase of late-stage cancer care.

The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF): a new measure.

Objectives: Caregivers and cancer patients frequently have conflicting and unmet communication needs. The Cancer Communication Assessment Tool for Patients and Families (CCAT‐PF) is a new instrument that assesses congruence in patient–family caregiver communication for both research and clinical purposes.

A coping and communication support intervention tailored to older patients diagnosed with late-stage cancer

As our society ages, increasing numbers of older Americans will be diagnosed and eventually will die of cancer. To date, psycho-oncology interventions for advanced cancer patients have been more successful in reaching younger adult age groups and generally have not been designed to respond to the unique needs and preferences of older patients. Theories and research on successful aging (Baltes and Baltes 1990; Baltes 1997), health information processing style (Miller 1995; Miller et al 2001) and non-directive client-centered therapy (Rogers 1951, 1967), have guided the development of a coping and communication support (CCS) intervention. Key components of this age-sensitive and tailored intervention are described, including problem domains addressed, intervention strategies used and the role of the CCS practitioner. Age group comparisons in frequency of contact, problems raised and intervention strategies used during the first six weeks of follow up indicate that older patients were similar to middle-aged patients in their level of engagement, problems faced and intervention strategies used. Middle-aged patients were more likely to have problems communicating with family members at intervention start up and practical problems as well in follow up contacts. This is the first intervention study specifically designed to be age sensitive and to examine age differences in engagement from the early treatment phase for late-stage cancer through end of life. This tailored intervention is expected to positively affect patients’ quality of care and quality of life over time.

Generalists and Oncologists Show Similar Care Practices and Outcomes for Hospitalized Late-Stage Cancer Patients

Objective.The objective of this work was to identify similarities and differences in primary attending physicians’ (generalists’ versus oncologists’) care practices and outcomes for seriously ill hospitalized patients with malignancy. Design.This was a prospective cohort study (SUPPORT project). Setting.Subjects were recruited from 5 US teaching hospitals; data were gathered from 1989 to 1994. Subjects.Included in the study was a matched sample of 642 hospitalized patients receiving care for non–small-cell lung cancer, colon cancer metastasized to the liver, or multiorgan system failure associated with malignancy with either a generalist or an oncologist as the primary attending physician. Measurements.Care practices and patient outcomes were determined from hospital records. Length of survival was identified with the National Death Index. Physicians’ perceptions of patient’s prognosis, preference for cardiopulmonary resuscitation (CPR), and length of relationship were assessed by interview. A propensity score for receiving care from an oncologist was constructed. After propensity-based matching of patients, practices and outcomes of oncologists’ and generalists’ patients were assessed through group comparison techniques. Results.Generalist and oncologist attendings showed comparable care practices, including the number of therapeutic interventions, eg, “rescue care” and chemotherapy, and the number of care topics discussed with patients/families. Length of stay, discharge to supportive care, readmission, total hospital costs, and survival rates were similar. For both physician groups, perception of patients’ wish for CPR was associated with rescue care (P <0.03), and such care was related to higher hospital costs (P <0.000). Poorer prognostic estimates predicted aggressiveness-of-care discussions by both types of physicians. Length of the patient-doctor relationship was associated with oncologists’ care practices. More documented discussion about aggressiveness of care was related to higher hospital costs and shorter survival for patients in both physician groups (P <0.001). Conclusions.Generalists and oncologists showed similar care practices and outcomes for comparable hospitalized late-stage cancer patients. Physicians’ perceptions about patients’ preferences for CPR and prognosis influenced decision making and outcomes for patients in both physician groups. Length of relationship with patients was associated only with oncologists’ care practices. Rescue care increased hospital costs but had no effect on patient survival. Future studies should compare physicians’ palliative care as well as acute-care practices in both inpatient and ambulatory care settings. Patients’ end-of-life quality and interchange between physician groups should also be documented and compared.

Patterns of adaptation in patients living long term with advanced cancer

With improved treatment, increasing proportions of patients with advanced cancer are surviving longer with their disease: into a second year after diagnosis and beyond. These longer term survivors face continuing challenges in selecting and shifting personal life goals and goals of care over years (rather than months) of life with incurable cancer. Studies are needed to explore adaptation over time in patients who are living longer term with late‐stage cancer, including anxiety, depression, and spiritual well being, which are conceptualized as indicators of psychospiritual well being in patients with advanced cancer.

Relationships and emotional wellbeing among African American and White advanced cancer caregivers.

OBJECTIVE Advanced cancer family caregivers who have good relationships with other family members and with patients health care providers (PHCPs) have less emotional distress than caregivers with poor relationships. Given a history of different experiences in medical settings among Whites and African Americans, we examined moderation effects by race. METHODS Baseline data from an ongoing study were collected via telephone interviews with 397 family caregivers of advanced cancer patients at two cancer clinics. Depressed mood and anxiety were measured with the 14-item Profile of Mood States. RESULTS Caregivers reporting good relationships with family (p<.001) and PHCPs (p<.001) had lower anxiety and less depressed mood (family, p<.01; PHCP, p<.001). Caregiver race moderated relationship quality: Whites with good PHCP relationships felt less depressed mood (p<.01) and anxiety (p<.01). African Americans with good family relationships showed less depressed mood (p<.05), but no association with anxiety. CONCLUSION Good relationships are important for caregivers, but PHCPs may have more influence on the wellbeing of White than of African American caregivers. PRACTICE IMPLICATIONS Developing relationships with caregivers of advanced cancer patients may improve wellbeing for caregivers. In addition, creating strategies to support family relationships may be a useful intervention, especially for African American advanced cancer caregivers.

The Role of Primary Care Physicians in Advanced Cancer Care: Perspectives of Older Patients and Their Oncologists

OBJECTIVES: To examine data from advanced cancer patients and their oncologists regarding patient age‐related differences in patient and oncologist perspectives on involvement of primary care physicians (PCPs) in aspects of cancer management.

Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and Research

This supplement is a compilation of original work that was presented at an interdisciplinary conference on “Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and Research” held in Cleveland, Ohio, April 3 to 4, 2008. An audience of 77 clinicians and researchers attended this conference, primarily coming from Ohio and adjacent states. Articles are organized around a conceptual framework to consider primary and shared care roles of primary care physicians (PCPs) and oncologists in the care of older patients with cancer and their families. Articles in Section One focus on evidence‐based clinical practice and recommendations. Section Two includes articles on original psychosocial and health services research that inform this topic. Papers in this conference were developed in recognition of the greater prevalence and growing incidence of cancer in older adults; the unique geriatric expertise and practice considerations essential to the prevention and control of cancer in older adults; the important and effective roles that PCPs may play in such care; and the need to develop shared care models that foster collaboration between PCPs and oncologists, from cancer prevention through long‐term survivorship and end‐of‐life care of older adults. Models of shared care between oncologists and PCPs should be tested and compared for optimal care of older patients with cancer and their families. Potential implications of ideally shared care include more‐informed patient‐centered decision‐making, better adherence to treatment, improved match between older patient goals and treatments, and thus better outcomes.

Health and well-being in older married female cancer survivors.

OBJECTIVES: To investigate differences between older married female cancer survivors and a matched comparison sample on physical health and on effects of health on depressive symptomatology.

Grief and Risk of Depression in Context The Emotional Outcomes of Bereaved Cancer Caregivers

We investigated the relationships of grief and depression to cancer caregiving in early bereavement. We began with three expectations: (a) each outcome would reflect different situational predictors, (b) grief would be more directly related to such predictors, and (c) components of grief would relate differently to the caregiving context and depressed mood. We conducted telephone interviews with family caregivers of incurable cancer patients from two hospitals. A total of 199 family caregivers were interviewed at the time of the patient’s diagnosis and reinterviewed 3 months after the patient’s death. Results showed grief severity was predicted by caregiving circumstances, but bereavement depressed mood was largely unrelated to caregiving. Grief was the main predictor of depressed mood and mediated almost all other effects. We conclude that while grief may trigger depression, the dissimilar connection to context means that the two emotional states should not be equated based purely on similarity of expression.