Determinants of patient-family caregiver congruence on preferred place of death in taiwan.
ABSTRACT Patient-family caregiver congruence on preferred place of death not only increases the likelihood of dying at home but also contributes significantly to terminally ill cancer patients' quality of life.
To examine the determinants of patient-family caregiver congruence on the preferred place of death in Taiwan.
Patient-family caregiver dyads (n=1,108) were surveyed on preferences and needs for end-of-life (EOL) care. Determinants of congruence on preferences were identified by multivariate logistic regression.
Patient-caregiver dyads achieved 78.1% agreement on the preferred place of death. The kappa coefficient of congruence was 0.55 (95% confidence interval [CI]=0.50, 0.60). The extent of patient-family caregiver congruence on preferred place of death increased with the patient's higher functional dependence (adjusted odds ratio [AOR] and 95% CI=1.04 [1.02, 1.05]), higher patient-rated importance for dying at preferred place of death (AOR [95% CI]=1.60 [1.43, 1.79]), and having a spousal caregiver (AOR [95% CI]=1.62 [1.14, 2.31]). Other determinants of patient-family caregiver congruence included patient age (AOR [95% CI]=1.01 [1.00, 1.03]), patient-family concordance on preferred EOL care options (AOR=1.68-1.73), patient knowledge of prognosis (AOR [95% CI]=0.68 [0.48, 0.97]), and impact of caregiving on the family caregiver's life (AOR [95% CI]=0.98 [0.96, 0.99]).
Increasing patient-family congruence on preferred place of death not only requires knowledge of the patient's prognosis and advance planning by both parties but also depends on family caregivers endorsing patient preferences for EOL care options and ensuring that supporting patients dying at home does not create an intolerable burden for family caregivers.
Article: Sleep-wake disturbances in patients with cancer and their informal caregivers: a matter of dyads[show abstract] [hide abstract]
ABSTRACT: INTRODUCTION Sleep is a vital human process known to be essential for health, well-being, and optimal physical and psychological functioning [1, 2]. It is therefore reasonable to argue that sleep-wake disturbances may have serious consequences on the equilibrium of life [3, 4]. Sleep difficulties have been reported as a frequent complication of and are associated with various clinical conditions . Over the last fifteen years, the attention of the scientific community has shifted towards systematic investigation of sleep disorders during the experience of cancer as an important aspect of care. A cancer diagnosis severely disturbs a person's continuum of life. Sudden changes imposed after the diagnosis and during the ensuing anticancer treatment may profoundly affect the person, resulting in several sources of discomfort, among which sleep-wake disturbances and poor sleep quality . Especially throughout the period of diagnosis and treatment, but also during survivorship or, conversely, during palliative care, people with cancer are in great need of support. To a significant extent this support is expected to be provided by their significant others, family members or friends, whom patients feel they receive support from, and are frequently recognized as their informal caregivers . Their practical and emotional involvement, however, often and in other cases considerably affects the caregivers' own lives . Caregiving can be so demanding and stressful that the burden on these persons may lead to disruptions in their sleep as well .Forum of Clinical Oncology. 05/2012;