[Show abstract][Hide abstract] ABSTRACT: To identify changes in positive aspects of care (PAC) from the time of diagnosis to four months following the diagnosis in family caregivers of care recipients with primary malignant brain tumors.
Dyads were recruited from neurosurgery clinics in Pittsburgh, PA, at the time of care recipients' diagnosis with a primary malignant brain tumor. A second data collection took place four months following the diagnosis.Sample: 89 caregiver and care recipient dyads.
Paired t tests were used to examine change in PAC, univariate analyses were used to determine predictors of PAC at four months, Mann-Whitney U tests and t tests were used to examine associations between categorical predictor variables and PAC at four months, and univariate linear regressions were used to examine associations between continuous predictors and PAC at four months.
The impact of sociodemographic factors, caregiver-perceived social support, mastery, neuroticism, and marital satisfaction on PAC.
Caregivers' PAC scores during the first four months following diagnosis appeared to remain stable over time. Significant differences were found between the care recipient reasoning domain group at diagnosis and PAC score. Care recipients who scored below average were associated with caregivers with higher PAC scores. Caregiver PAC at four months following diagnosis was significantly predicted by care recipient reasoning and caregiver social support.
PAC scores appear to remain stable over time, although levels of PAC may be related to care recipients' level of functioning. Future research should focus on the development of interventions for caregivers who report low levels of PAC at the time of diagnosis in an attempt to help these individuals identify PAC in their caregiving situation.
Findings have clinical and research implications. Clinicians may be able to better identify caregivers who are at risk for negative outcomes by understanding the risks faced by caregivers of patients with milder symptoms in addition to those caring for more profoundly affected care recipients.
Oncology Nursing Forum 05/2012; 39(3):E226-32. DOI:10.1188/12.ONF.E226-E232 · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims: Spirituality has been shown to be an important coping mechanism for people in crisis, yet little is known regarding how an individual’s spirituality changes when caring for a person diagnosed with cancer and whether spirituality influences emotional distress. The aims of this analysis, in family caregivers of persons with primary malignant brain tumors (PMBTs), were to 1) determine if caregivers’ spirituality changes over the course of the disease trajectory, and 2) examine the impact of spirituality on caregiver depressive symptoms and anxiety eight months after diagnosis.
Methods: Family caregiver-care recipient dyads (n=50) were recruited within a month of the care recipient’s diagnosis. Data from telephone interviews at baseline, 4, and 8 months using the FACIT-Sp, CES-D, and sociodemographic-treatment questionnaires were included in analyses. ANOVA was used to evaluate change over time and linear regression to examine the role of spirituality in depressive symptoms and anxiety.
Results: The FACIT-Sp score (baseline mean=35.1; SD= 8.3; scale 0-48) did not change significantly across the disease trajectory. Regression analyses revealed higher spirituality was significantly associated with both lower depressive symptoms (p<.01) and lower levels of anxiety (p<.01) in caregivers at 8 months following diagnosis.
Spirituality appears to be a stable characteristic during the care recipient’s disease trajectory and may play an important role in caregivers’ emotional health.
CANS 2010 State of the Science Congress on Nursing Research; 09/2010
[Show abstract][Hide abstract] ABSTRACT: Cognitive deficits in participants and the abrupt and traumatic way in which many neurological conditions present are two examples of the unique challenges in recruiting and retaining participants with neurological injury for research studies. The purpose of this investigation was to identify obstacles to recruitment and retention in three ongoing research studies. These studies involve persons with neurological disorders across the continuum of care, from those newly diagnosed and with emergent presentation to those with more established chronic neurological conditions. For this analysis, we evaluated the effectiveness of the strategies employed to improve participation rates. The first study was a project funded by the National Institutes of Health designed to identify biomarkers of vasospasm in persons (n = 496) with aneurysmal subarachnoid hemorrhage who presented to the neurovascular intensive care unit (National Institute of Nursing Research, R01 NR004339). The purpose of the second study was to examine biobehavioral interactions in family caregivers (n = 59) of persons with a primary malignant brain tumor recruited in the community setting. The third project involved recruiting persons (n = 1,019) within an outpatient neurosurgical center to participate in a research registry. To determine differential effectiveness of strategies, consent and attrition rates were calculated at serial points over time in three studies, and recruitment and retention strategies were compared. Sentinel time points in participants' disease trajectories played a key role in determining whether those who were approached to participate gave consent and were retained, particularly in the studies involving persons with aneurysmal subarachnoid hemorrhage (consent = 85%; retention = 89%) and persons with primary malignant brain tumors and their caregivers (consent = 68%; retention = 83%). In addition, several specific recruiter and interviewer training techniques were associated with higher recruitment and retention. Targeted strategies to improve participation rates are vital for neuroscience nurses involved in any aspect of clinical research, including those who conduct studies, assist with data collection, and recruit potential participants.
[Show abstract][Hide abstract] ABSTRACT: Although several studies have quantified costs of cancer care; none to date have examined how cancer costs impact family caregivers' emotional health. This study was designed to evaluate how perceptions of economic hardship influence burden, depressive symptoms, and anxiety in family caregivers of persons with a primary malignant brain tumor. Caregiver (CG)/patient dyads (n = 33) were recruited at the time of diagnosis; data were collected at diagnosis and 4 months, and linear regression determined the impact of economic hardship on caregivers' emotional health. Economic hardship did not predict CG burden-schedule at diagnosis or 4 months. Economic hardship predicted burden-abandonment at diagnosis (P < 0.01), but not 4 months. There was a trend for economic hardship to predict CG depressive symptoms at 4 months (P = 0.09), but not at diagnosis. Economic hardship predicted CG anxiety at 4 months (P = 0.06), but not diagnosis. Results suggest caregivers' economic hardship is an important and dynamic aspect of the emotional health of neuro-oncology family caregivers.
Journal of Neuro-Oncology 07/2009; 93(3):333-42. DOI:10.1007/s11060-008-9778-z · 3.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Established models of breast cancer risk, such as the Gail model, do not account for patterns of the disease in women under the age of 35, especially in African Americans. With the possible exceptions of ionizing radiation or inheriting a known genetic mutation, most of the known risk factors for breast cancer are related to cumulative lifetime exposure to estrogens. Increased risk of breast cancer has been associated with earlier onset of menses or later age at menopause, nulliparity or late first parity, use of hormonal contraceptives or hormone replacement therapy, shorter lactation history, exposure to light at night, obesity, and regular ingestion of alcohol, all of which increase circulating levels of unbound estradiol. Among African Americans at all ages, use of hormone-containing personal care products (PCPs) is more common than among whites, as is premature appearance of secondary sexual characteristics among infants and toddlers. We hypothesize that the use of estrogen and other hormone-containing PCPs in young African American women accounts, in part, for their increased risk of breast cancer prior to menopause, by subjecting breast buds to elevated estrogen exposure during critical windows of vulnerability in utero and in early life. These early life and continuing exposures to estrogenic and xenoestrogenic agents may also contribute to the increased lethality of breast cancer in young women in general and in African American women of all ages. Public disclosure by manufacturers of proprietary hormonally active ingredients is required for this research to move forward.
Medical Hypotheses 02/2007; 68(4):756-66. DOI:10.1016/j.mehy.2006.09.039 · 1.07 Impact Factor