Existential behavioral therapy for informal caregivers of palliative patients: Barriers and promoters of support utilization

Thurn, Tamara; Brandstätter, Monika; Fensterer, Veronika; Küchenhoff, Helmut; Fegg, Martin

doi:10.1017/s1478951514000546

Cited by 4 publications

(4 citation statements)

References 37 publications

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“…The aims of this study were to assess the feasibility and acceptability of a gratitude intervention for patients and carers and provide a preliminary assessment of its effects. Our results indicate good feasibility: eligibility rates were particularly encouraging; patient’s participation rate was comparable to other psychosocial and existential intervention studies [ 48 – 52 ] and improved in phase 2; carers’ participation rate was particularly high; and attrition rates were quite low for carers albeit high for patients, mainly because of progressing illness. Still, 82% of the patients who started the study completed it.…”

Section: Discussionsupporting

confidence: 77%

Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers

et al. 2023

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Background Psychological research examining the nature and workings of gratitude has burgeoned over the past two decades. However, few studies have considered gratitude in the palliative care context. Based on an exploratory study which found that gratitude was correlated with better quality of life and less psychological distress in palliative patients, we designed and piloted a gratitude intervention where palliative patients and a carer of their choice wrote and shared a gratitude letter with each other. The aims of this study are to establish the feasibility and acceptability of our gratitude intervention and provide a preliminary assessment of its effects. Methods This pilot intervention study adopted a mixed-methods, concurrent nested, pre-post evaluation design. To assess the intervention’s effects, we employed quantitative questionnaires on quality of life, quality of relationship, psychological distress, and subjective burden, as well as semi-structured interviews. To assess feasibility, we considered patients and carers’ eligibility, participation and attrition rates, reasons for refusal to participate, appropriateness of intervention timeframe, modalities of participation, and barriers and facilitators. Acceptability was assessed through post-intervention satisfaction questionnaires. Results Thirty-nine participants completed the intervention and twenty-nine participated in interviews. We did not find any statistically significant pre/post intervention changes for patients, but found significant decrease in psychological distress for carers in terms of depression (median = 3 at T0, 1.5 at T1, p = .034) and total score (median = 13 at T0, 7.5 at T1, p = .041). Thematic analysis of interviews indicates that overall, the intervention had: (1) multiple positive outcomes for over a third of interviewees, in the form of positive emotional, cognitive, and relational effects; (2) single positive outcomes for nearly half of interviewees, who experienced emotional or cognitive effects; (3) no effect on two patients; and (4) negative emotional effects on two patients. Feasibility and acceptability indicators suggest that the intervention was well received by participants, and that it should adopt flexible modalities (e.g. writing or dictating a gratitude message) to ensure that it is feasible and adapted to individual needs and preferences. Conclusions Larger scale deployment and evaluation of the gratitude intervention, including a control group, is warranted in order to have a more reliable evaluation of its effectiveness in palliative care.

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Section: Discussionsupporting

confidence: 77%

Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers

et al. 2023

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“…Eligibility rates were particularly encouraging, at 47% for patients and 100% for carers. Patient's participation rate was 28%, which is comparable to other psychosocial and existential intervention studies (41)(42)(43)(44)(45), whilst carers' participation rate was particularly high at 75%. Lastly, attrition rates were 11% for carers, which is quite low, and 39% for patients, mainly because of death and progressing illness.…”

Section: Intervention Feasibility and Acceptabilitysupporting

confidence: 66%

Giving and receiving thanks: A mixed methods pilot study of a gratitude intervention for palliative patients and their carers

Bernard

Poncin

Bovet

et al. 2022

Preprint

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Background Psychological research examining the nature and workings of gratitude has burgeoned over the past two decades. However, few studies have considered gratitude in the palliative care context. Based on an exploratory study which found that gratitude was correlated with better quality of life and less psychological distress in palliative patients, we designed and piloted a gratitude intervention where palliative patients and a carer of their choice wrote and shared a gratitude letter with each other. The aims of this study are to establish the feasibility and acceptability of our gratitude intervention and provide a preliminary assessment of its effects. Methods This pilot intervention study adopted a mixed-methods, pre-post evaluation design. To assess the intervention’s effects, we employed quantitative questionnaires on quality of life, quality of relationship, psychological distress, and subjective burden, as well as semi-structured interviews. To assess feasibility, we considered patients and carers’ eligibility, participation and attrition rates, reasons for refusal to participate, appropriateness of intervention timeframe, modalities of participation, and barriers and facilitators. Acceptability was assessed through post-intervention satisfaction questionnaires. Results Thirty-nine participants completed the intervention. We did not find any statistically significant pre/post intervention changes for patients, but found significant decrease in psychological distress for carers in terms of depression (median = 3 at T0, 1.5 at T1, p = .034) and total score (median = 13 at T0, 7.5 at T1, p = .041). Qualitative analysis indicates that overall, the intervention had: (1) multiple positive outcomes for 11 participants, in the form of positive emotional, cognitive, and relational effects; (2) simple positive outcomes for 14 participants, who experienced emotional or cognitive effects; (3) no effect on two patients; and (4) negative emotional effects on two patients. Feasibility and acceptability indicators suggest that the intervention was well received by participants, and that it should adopt flexible modalities (e.g. writing or dictating a gratitude message) to ensure that it is feasible and adapted to individual needs and preferences. Conclusions Larger scale deployment and evaluation of the gratitude intervention, including a control group, is warranted in order to have a more reliable evaluation of its effectiveness in the palliative care setting.

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“…In palliative care, this model was successfully used to describe inequity related to adult patients' age [8], to paediatric patients [9][10][11], to family caregivers of palliative care patients [12,13] and to cancer survivors [14]. None of these studies specifically focussed on the health determinants in advanced cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Inequity in palliative care service full utilisation among patients with advanced cancer: a retrospective Cohort study

D’Angelo¹,

Nitto

Giannarelli

et al. 2020

Acta Oncologica

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Background: Advanced cancer patients often die in hospital after receiving needless, aggressive treatment. Although palliative care improves symptom management, barriers to accessing palliative care services affect its utilisation, and such disparities challenge the equitable provision of palliative care. This study aimed to identify which factors are associated with inequitable palliative care service utilisation among advanced cancer patients by applying the Andersen Behavioural Model of Health Services Use. Material and methods: This was a retrospective cohort study using administrative healthcare data. A total of 13,656 patients residing in the Lazio region of Italy, who died of an advanced cancer-related cause-either in hospital or in a specialised palliative care facility-during the period of 2012-2016 were included in the study. Potential predictors of specialised palliative service utilisation were explored by grouping the following factors: predisposing factors (i.e., individuals' characteristics), enabling factors (i.e., systemic/structural factors) and need factors (i.e., type/severity of illness). Results: The logistic hierarchical regression showed that older patients (odds ratio [OR] ¼ 1.45; <0.0001) of Caucasian ethnicity (OR ¼ 4.17; 0.02), with a solid tumour (OR ¼ 1.87; <0.0001) and with a longer survival time (OR ¼ 2.09; <0.0001) were more likely to be enrolled in a palliative care service. Patients who lived farther from a specialised palliative care facility (OR ¼ 0.13; <0.0001) and in an urban area (OR ¼ 0.58; <0.0001) were less likely to be enrolled. Conclusion:This study found that socio-demographic (age, ethnicity), clinical (type of tumour, survival time) and organisational (area of residence, distance from service) factors affect the utilisation of specialised palliative care services. The fact that service utilisation is not only a function of patients' needs but also of other aspects demonstrates the presence of inequity in access to palliative care among advanced cancer patients.

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Existential behavioral therapy for informal caregivers of palliative patients: Barriers and promoters of support utilization

Cited by 4 publications

References 37 publications

Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers

Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers

Giving and receiving thanks: A mixed methods pilot study of a gratitude intervention for palliative patients and their carers

Inequity in palliative care service full utilisation among patients with advanced cancer: a retrospective Cohort study

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