Family caregivers as partners in care transitions: The caregiver advise record and enable act

Coleman, Eric A.

doi:10.1002/jhm.2637

Cited by 65 publications

(54 citation statements)

References 7 publications

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“…Because HNC caregivers prefer to receive informational support directly from health care providers (Longacre, Galloway, Parvanta, & Fang, 2015), results from this study highlight that oncology clinicians could target higher-risk HNC dyads (e.g., those facing more severe symptoms) who may especially benefit from screening and supportive resources before treatment. This research fits with recent national efforts by the American Association of Retired Persons (http://aarp.org) to pass state legislation requiring the systematic identification, documentation, and training of caregivers in the hospital setting [Caregiver Advise, Record, and Enable Act; (Coleman, 2016)]. In building better systems for addressing HNC caregiver needs, dyads with compromised well-being at diagnosis should be targeted for proactive provision of educational resources and referrals.…”

Section: Resultssupporting

confidence: 67%

Physical and emotional well-being and support in newly diagnosed head and neck cancer patient–caregiver dyads

Sterba

Zapka

Armeson

et al. 2017

Journal of Psychosocial Oncology

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The purpose of this study was to examine the physical and emotional well-being and social support in newly diagnosed head and neck cancer (HNC) patients and caregivers and identify sociodemographic, clinical, and behavioral risk factors associated with compromised well-being in patients and caregivers. Newly diagnosed HNC patients and their primary caregivers (N = 72 dyads) completed questionnaires before treatment assessing physical and mental well-being, depression, cancer worry, and open-ended support questions. Patients reported worse physical well-being than caregivers (p < 0.05) but similar levels of mental well-being. Caregivers reported providing emotional and instrumental support most frequently with an emphasis on nutrition and assistance with speech, appearance, and addictions. Both patients and their caregivers reported suboptimal mental well-being and depression. Smoking was associated with compromised well-being in patients, caregivers, and dyads. Compromised well-being in patients and their caregivers was more likely when patients were younger, had worse symptoms, and smoked/consumed alcohol (p < 0.05). While patients face more physical strain than caregivers, both equally confront emotional challenges. Results highlight risk factors for compromised well-being in both patients and their caregivers that should be assessed at diagnosis to guide identification of needed dyadic-focused supportive care resources.

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Section: Resultssupporting

confidence: 67%

Physical and emotional well-being and support in newly diagnosed head and neck cancer patient–caregiver dyads

Sterba

Zapka

Armeson

et al. 2017

Journal of Psychosocial Oncology

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“…These processes and findings could be shared through dedicated time in daily interdisciplinary rounds. The involvement of caregivers and their ability to support patients at home could be more‐robustly tested in the hospital before discharge, and caregiver support could be enhanced . Fine‐tuning patient selection requires greater knowledge of SNF capabilities and context; novel models for exposing housestaff and hospitalists to SNF are needed.…”

Section: Discussionmentioning

confidence: 99%

“…The involvement of caregivers and their ability to support patients at home could be more-robustly tested in the hospital before discharge, and caregiver support could be enhanced. 43,44 Fine-tuning patient selection requires greater knowledge of SNF capabilities and context; novel models for exposing housestaff and hospitalists to SNF are needed. Ultimately, the current "push" model from hospitals to SNFs may require a paradigm shift to a "pull" model, where SNF clinicians who know the postdischarge context are more involved in the decision-making process.…”

Section: Nurse (University 1)mentioning

confidence: 99%

How Hospital Clinicians Select Patients for Skilled Nursing Facilities

Burke

Lawrence

Ladebue

et al. 2017

J American Geriatrics Society

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Background/Objective Hospitalized older adults are frequently transferred to skilled nursing facilities (SNFs) for post-discharge care. Hospitals and SNFs are increasingly held jointly accountable for costs and outcomes of this care. However, it is unclear how clinicians select patients for SNF care; we sought to understand how hospital-based clinicians evaluate older adults in the hospital and decide who will be transferred to a SNF for post-acute care. Design Semi-structured interviews paired with a qualitative analytic approach informed by Social Constructivist theory. Setting Inpatient care units in three hospitals. We used purposive sampling to maximize variability in hospitals, units within hospitals, and staff on those units. Participants Twenty-five clinicians involved in evaluation and decision-making regarding post-acute care, including hospitalists, nurses, therapists, social workers, and case managers. Measurements Central themes related to clinician evaluation and discharge decision-making. Results Clinicians described pressure to expedite evaluation and discharge decisions, resulting in the use of SNF as a “safety net” for older adults being discharged from the hospital. The lack of hospital-based clinician knowledge of SNF care practices, quality, or patient outcomes resulted in the lack of a standardized evaluation process or a clear primary decision-maker. Conclusion Hospital clinician evaluation and decision-making about post-acute care in a SNF may be characterized as rushed, without a clear system or framework for making decisions, and uninformed by knowledge of SNF or patient outcomes in those discharged to SNF. This leads to SNF being used as a “safety net” for many older adults. As hospitals and SNFs are increasingly held jointly accountable for outcomes of patients transitioning between hospital and SNF, novel solutions for improving evaluation and decision-making are urgently needed.

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“…Understanding the health history and functional status of spouses of patients with HF is important to consider when planning for the care of patients with HF, as some married patients may require assistance with daily tasks that their spouses cannot physically provide. While there has been increased recognition of the importance of identifying and clearly communicating care responsibilities with informal caregivers 25 , it is also essential to assess the health and well-being of those caregivers so that potential gaps in care can be addressed.…”

Section: Discussionmentioning

confidence: 99%

Patient and Spousal Health and Outcomes in Heart Failure

Dunlay

Roger

Weston

et al. 2017

Circ: Heart Failure

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Background A diagnosis of heart failure (HF) often requires a comprehensive lifestyle change to maintain disease stability. When patients with HF are married, the spouse frequently assumes the caregiving role. Our objectives were to describe the health of spouses of married patients with HF, and examine if the health of a spouse impacts patient outcomes. Methods and Results We identified 905 patients that were married at the time of incident HF diagnosis in Olmsted County, Minnesota from 2000-2012. Using Rochester Epidemiology Project resources, the patient and their spouse's comprehensive longitudinal health histories were linked. Spousal health at patient HF diagnosis was assessed by comorbidity burden, self-reported difficulty with activities of daily living (ADL) and prior hospitalizations. The associations of spousal health with patient outcomes and patient death with spousal outcomes were examined using Cox and Andersen-Gill models. Spouses of patients with HF were elderly (mean age 71 years), often had comorbid conditions, and 16% had difficulty with one or more ADLs. After adjustment for patient age, sex, and comorbidity, there were no independent associations of spousal health and patient risk of death or hospitalization after HF diagnosis. However, the risk of hospitalization (adjusted hazard ratio, HR, 1.34, 95% CI 1.11-1.60, p=0.002) and death (HR 2.10, 95% CI 1.60-2.75, p<0.001) increased in the surviving spouse after patient death. Conclusions We found no evidence that the health of a spouse impacts patient outcomes after HF diagnosis. However, after a patient with HF dies, their surviving spouse's risk of hospitalization and death increases.

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Family caregivers as partners in care transitions: The caregiver advise record and enable act

Cited by 65 publications

References 7 publications

Physical and emotional well-being and support in newly diagnosed head and neck cancer patient–caregiver dyads

Physical and emotional well-being and support in newly diagnosed head and neck cancer patient–caregiver dyads

How Hospital Clinicians Select Patients for Skilled Nursing Facilities

Patient and Spousal Health and Outcomes in Heart Failure

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