Symptoms in Family Caregivers of Patients Undergoing Radiation Therapy for Prostate Cancer

Changes in the US health care system have resulted in increased numbers of patients with cancer being cared for at home by family caregivers (FCs). The prevalence, severity, and impact of five symptoms (depression, anxiety, sleep disturbance, fatigue, pain) were evaluated in 60 FCs of patients with prostate cancer at the initiation of radiation therapy (RT). A high percentage of FCs experienced clinically significant levels of a variety of symptoms, which had a negative effect on the FC's functional status and quality of life (QOL). Two longitudinal studies were conducted that examined two of the most prevalent symptoms in FCs (i.e., fatigue, anxiety). Based on the results of hierarchical linear modeling (HLM), the trajectories and predictors of evening and morning fatigue were different. The model of evening fatigue was quadratic and the predictors of the intercept were baseline levels of FC sleep disturbance and baseline levels of patient evening fatigue, while the predictors for the slopes was baseline levels of FC evening fatigue. In contrast, the trajectories for morning fatigue were linear. The predictors of the intercept were baseline level of FC trait anxiety, baseline levels of patient morning fatigue, and level of family support. Anxiety was a highly prevalent symptom in this sample of FCs. Based on the unconditional HLM model, these FCs reported clinically significant levels of anxiety at the time of the patients' simulation visit that decreased only slightly over the course of the study. Higher levels of depression and morning fatigue in FCs at the time of the simulation visit as well as caring for a younger patient were associated with increased anxiety. In addition, the level of FC sleep disturbance at baseline had a significant impact on the trajectories of FC anxiety. These studies revealed a high prevalence of symptoms which had a negative effect on functional status and QOL in FCs of patients undergoing RT for prostate cancer. HLM analyses highlighted the large amount of variability in fatigue and anxiety in these FCs. The symptoms of fatigue and anxiety in FCs evidenced the influence of the patient characteristics as predictors

Coping styles, health status and advance care planning in patients with hematologic malignancies

This study evaluated if measures of psychological well-being, including coping style are associated with advance care planning (ACP). Data were from the HEMA-COMM study, a prospective observational study of physician-patient communication in patients with hematologic malignancies. ACP was defined as having a living will, having a health care proxy, discussing life support with family or friends, and discussing life support with a doctor or nurse. 293 patients participated: only 45 (15%) had all the elements of ACP, 215 (73%) had at least 1 element of ACP, while 33 (11%) did not engage in ACP. In multivariate analysis, specific coping styles but not other measures of psychosocial well being were associated with having written ACP. Verbal ACP was associated with patient-reported health and physician estimate of life expectancy. Our study suggests that tailoring ACP discussions to a patient’s coping style may increase engagement in ACP

Towards a Definition of Caregiver Fatigue

Using Walker and Avant\u27s approach, a concept analysis was performed to develop a working definition of caregiver fatigue. Defining attributes of caregiver fatigue identified were fell into role by default, outside the norm of role expectations, excess caregiving demand, and exposure to prolonged period of caregiving. Model, related, and contrary cases were developed. Antecedent, consequences, and empirical referent of caregiver fatigue were also identified. Lastly, a working definition of caregiver fatigue was developed