Abstract
Assuming and carrying out the care of patients with chronic conditions who will no longer respond to curative interventions, i.e., palliative care, represents a significant emotional and behavioral burden, with cognitive implications and harmful effects on the health of those who provide such care. In developing countries, this responsibility often falls on family members who receive no financial compensation and get exposed to all the stressors of the situation, with serious adverse effects on their psychological adjustment and physical health. The present study evaluated a cognitive behavioral, problem-solving intervention in caregivers of palliative care patients in a large public hospital in Mexico City. The results revealed from modest to large improvements in the self-care behaviors of the participating caregivers. The main findings' discussion revolves around the context of unmet institutional needs and recommendations for designing and delivering interventions and methodological caveats for future studies.
References
Applebaum, A. y Breitbart, W. (2013). Care for the cancer caregiver: A systematic review. Palliative & Supportive Care, 11(3), 231-252. Doi: 10.1017/S14789515122000594
Boivin, A., Green, J., van der Meulen, J., Légaré, F. y Nolte, E. (2009). Why consider patients’ preferences?: A discourse analysis of clinical practice guideline developers. Medical Care, 47(8), 908-915. Doi: 10.1097/MLR.0b013e3181a81158
Bucher, J.A., Loscalzo, M., Zabora, J., Houts, P., Hooker, C. y BrintzenhofeSzoc, K. (2001). Problem-solving cancer care education for patients and caregivers. Cancer Practice, 9(2), 66-70. Doi:10.1046/j.1523-5394.2001.009002066.x
Cameron, J.I., Franche, R.L., Cheung, A.M. y Stewart, D.E. (2002). Lifestyle interference and emotional distress in family caregivers of advanced cancer patients. Cancer, 94(2), 521-527. Doi: 10.1002/cncr.1012
Candy, B., Jones, L., Drake, R., Leurent, B. y King, M. (2011). Interventions for supporting informal caregivers of patients in the terminal phase of a disease. Cochrane Database of Systematic Reviews, 1-75. Doi: 10.1002/14651858.CD007617.pub2
Demiris, G., Parker O., D., Washington, K.T. y Fruheling, L.T. (2010). A problem solving intervention for hospice caregivers: a pilot study. Journal of Palliative Medicine, 13, 1005-1011. Doi: 10.1089/jpm.2010.0022
Dionne-Odom, J.N., Demark-Wahnefried, W., Taylor, R.A., Rocque, G.B., Azuero, A., Acemgil, A., Martin, M.Y., Astin, M., Ejem, D., Kvale, E., Heaton, K., Pisu, M., Partridge, E.E. y Bakitas, M.A. (2017). The self-care practices of family caregivers of persons with poor prognosis cancer: differences by varying levels of caregiver well-being and preparedness. Support Care Cancer, 25(8), 2437-2444. Doi: 10.1007/s00520-017-3650-7
Frambres, D., Given, B., Letho, R., Sikorskii, A. y Wyatt, G. (2017). Informal caregivers of cancer patients: review of interventions, care, activities, and outcomes. Western Journal of Nursing Research, 40(7), 1069-1097. Doi: 10.1177/0193945917699364
Graham, J.E., Karmarkar, A.M., y Ottenbacher, K.J. (2012). Small sample research designs for evidence-based rehabilitation: issues and methods. Archives of Physical Medicine and Rehabilitation, 93(8 Suppl.), S111-S116. Doi: 10.1016/j.apmr.2011.12.017
Hudson, P. (2004). Positive aspects and challenges associated with caring for a dying relative at home. International Journal of Palliant Nursing, 10(2), 58-65.
Hudson, P., Remedios, C. y Thomas, K. (2010). A systematic review of psychological interventions for family carers of palliative care patients. BMC Palliative Care, 9(17), 2-6. Doi: 10.1186/1472-684x-9-17
Kazdin, A.E. (1994). Methodology, design, and evaluation in psychotherapy research. En A. E. Bergin y S. L. Garfield (Eds.): Handbook of psychotherapy and behavior change (pp. 19-71). John Wiley & Sons.
Kazdin, A.E. (1998). Research design in clinical psychology (3rd ed.). Allyn & Bacon.
Malouff, J.M., Thorsteinsson, E. y Schutte, N. (2007). The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis. Clinical Psychology Review, 27(1), 46-57.
McMillan, S.C., Small, B., Weitzner, M., Schonwetter, R. y Tittle, M. (2005). Impact of coping skills intervention with family caregivers of hospice patients with cancer. Cancer, 106(1). Doi: 10.1002/cncr.21567
Meyers, F.J., Carducci, M., Loscalzo, M.J., Linder, J., Greasby, T. y Beckett, L.A. (2011). Effects of a problem-solving intervention (COPE) on quality of life for patients with advanced cancer on clinical trials and their caregivers: simultaneous care educational intervention (SCEI), linking palliation, and clinical trials. Journal of Palliative Medicine, 14(4), 465-473. Doi: 10.1089/jpm.2010.0416
Neugaard, B., Andresen, E., McKune, S.L. y Jamoom, E.W. (2008). Health-related quality of life in a national sample of caregivers: Findings from the behavioral risk factor surveillance system. Journal of Happiness Studies, 9(4), 559-575. Doi: 10.1007/s10902-008-9089-2
Nezu, A.M., Nezu, C.M. y D’Zurilla, T.J. (2014). Terapia de solución de problemas. Manual de tratamiento. Bilbao: Desclée de Brouwer.
Northouse, L., Kataponi, M., Song, L., Zhang, L. y Mood, D. (2010). Interventions with family caregivers of cancer patients: meta-analysis of randomized trials. CA: A Cancer Journal for Clinicians, 60(5), 317-339. Doi: 10.3322/caac.20081
Parker, R.I. y Vannest, K. (2009). An improved effect size for single-case research: nonoverlap of all pairs. Behavior Therapy, 40(4), 357-367. Doi: 10.1016/j.beth.2008.10.006
Tang, S.T., Li, C.Y. y Chen, C., C.H. (2008). Trajectory and determinants of the quality of life of family caregivers of terminally ill cancer patients in Taiwan. Quality of Life Research, 17(3), 387-395. Doi: 10.1007/s11136-008-9316-7
Ussher, J.M., Perz, J., Hawkins, Y. y Brack, M. (2009). Evaluating the efficacy of psycho-social interventions for informal carers of cancer patients: a systematic review of the research literature. Health Psychology Review, 3(1), 85-107. Doi: 10.1080/17437190903033401
Van Houtven, C., Voils, C. y Weinberger, M. (2011). An organizing framework for informal caregiver interventions: detailing caregiving activities and caregiver and care recipient outcomes to optimize evaluation efforts. BMC Geriatry, 22(1), 11-77. Doi: 10.1186/1471-2318-11-77
Waldron, E.A., Janke, E.A., Bechtel, C.F., Ramirez, M. y Cohen, A. (2013). A systematic review of psychosocial interventions to improve cancer caregiver quality of life. Psycho-Oncology, 22(6), 1200-1207. Doi: 10.1002/ppon.3118
Williams, A.M., Wang, L. y Kitchen, P. (2014). Differential impacts of care‐giving across three caregiver groups in Canada: end‐of‐life care, long‐term care and short‐term care. Health & Social Care in the Community, 22(2), 187-196. Doi: 10.1111/hsc.12075