Search PubMed⌕ Search

Biomedical subjects

C W Given

Publications and source records attributed to C W Given.

At least 37 records · Page 2Linked to original sources
PubMed1996

Preliminary testing of the Long-Term Quality of Life (LTQL) instrument for female cancer survivors.

The purpose of this study was to develop a quality of life instrument for long-term female cancer survivors. A factor analysis (n = 188) of 34 items resulted in the Long-Term Quality of Life (LTQL) instrument. Internal consistency was high for the four subscales: somatic concerns (alpha = .86), spiritual/philosophical views of life (alpha = .87) fitness (alpha = .92) and social support (alpha = .88). These four factors are congruent with Ferrell's four theoretical domains of quality of life developed for women with breast cancer. Content validity was supported through interrater agreement of subscale items. Significant correlations between the LTQL and the CaRES, an established measure of quality of life, support the concurrent validity of the LTQL. Construct validity was supported by differential subscale scores according to demographic and health status data. Although the LTQL retained all of Ferrell's four domains of quality of life (physical, psychological, social, and spiritual) within one instrument, individual items reconfigured to suggest an overlapping of domains for the long-term female cancer survivor. This research suggests that the LTQL warrants further testing and may be a useful measure of quality of life in long-term female cancer survivors.

Adult↗
PubMed1995

Relationship of caregiver reactions and depression to cancer patients' symptoms, functional states and depression--a longitudinal view.

This research examined, in a sample of N = 150 cancer patients and caregivers, the relationships among patient's physical functioning, depression and symptomatology, impact on caregivers' schedule and health, and caregiver depression, as well as the changes in these variables over time. A measure of caregivers' optimism was also included in the analyses. The disposition of caregiver optimism was a strong predictor of caregiver reactions to the burdens of caring, and seemed to play the role of a personality characteristic which was for the most part independent of patient variables. Levels of patient symptoms and their change over time were both strongly linked to change in patient immobility over time. Patient symptoms, and to a lesser degree patient immobility, were strong predictors of patient depression which in turn predicted caregiver depression. In general, as patients' needs subsided, caregivers perceived fewer reactions to the burdens of caring. Caregivers' reactions were clearly distinct, and were influenced differently by different patient variables. However, all three types of caregivers' reactions were influenced by caregivers' optimism. Oncologists, nurses and other health care professionals involved in the care of patients with cancer should consider this potentially important personal characteristic in the assessment of need for and the development of interventions designed to assist patients with cancer and their family caregivers.

Adult↗
PubMed1995

Beyond patient dependency: family characteristics and access of elderly patients to home care services following hospital discharge.

Access to Skilled Nursing and Home Health Aid services among elderly patients (N = 580) and their family caregivers post hospital discharge was examined using logistic regression. A majority of the sample (65%) were referred for Skilled Nursing services while only 28% were referred for Home Health Aid services. Caregiving situations in which the spouse was the primary caregiver were less than half as likely to be referred for either service when compared to non-spouses. As expected, ADL limitations were a significant predictor of referral for both services. Women patients with the same ADL limitation as men were only about a fourth as likely to be referred for Home Health Aid services as men. Findings are discussed in terms of access to care and the need for policy to consider more than patient limitations in the referral criteria.

Activities of Daily Living↗
PubMed1995

Parent caregivers: a comparison of employed and not employed daughters.

A major task for social workers is sorting out the kinds of assistance needed by families who care for an elderly parent. In particular, information is needed about the differential effects of employment on daughters who care for their elderly parent. This study describes parental caregiving among three groups: daughters who were employed, daughters who were never employed while caregivers, and daughters who ended their employment to continue caregiving. The effects of caregiving on these three groups, as well as the daughters' involvement with care tasks and use of formal and informal assistance, are examined.

Adult↗
PubMed1994

The interaction of age, symptoms, and survival status on physical and mental health of patients with cancer and their families.

BACKGROUND: During the course of cancer treatment and as the disease progresses, symptoms may worsen and physical status may deteriorate. The interaction of age, symptoms, and nearness to death on the physical and mental health of patients and family members has not been examined. The research questions in this paper focus on how age and survival status influence the frequency and severity of patients' symptoms and dependencies in functioning. The impact of patient age and survival status on family depression, schedule, and health also are explored. METHODS: Cancer patients in treatment and their caregiver dyads (n = 208) were followed for 12 months. Survival status was measured by those who survived the year, those who died within 6 months, and those who died between 6 and 12 months. Measures used included frequency and severity counts of patient symptoms, functioning (activities of daily living [ADL] and immobility), depression, frequency of others' assistance to caregivers, and caregiver reactions to care. Analysis of variance was applied to test for significant differences according to age and survival status. RESULTS: Symptoms did vary significantly by survival status; however, age demonstrated no independent effect on patient variables including: symptom severity, patient depression, and ADL or immobility. When controlling for symptom severity and age, survival group had no effect on ADL status. For immobility, survival status continued to have a direct impact. Survival status does not influence dependencies in ADL but is related directly to losses in mobility. Significant differences occurred by survival groups for caregiver depression, caregiver reactions, and patient assistance. CONCLUSIONS: Strategies for assisting patients and families to deal with immobility are important. Family members require assistance for their distress as patient status deteriorates.

Activities of Daily Living↗
PubMed1994

The impact of age, treatment, and symptoms on the physical and mental health of cancer patients. A longitudinal perspective.

BACKGROUND: To describe continuing care and rehabilitation needs of cancer patients, a longitudinal design (6 months) was performed among patients 50 years of age and older with solid tumors. The study examined how age, type of treatment, site of cancer, and symptom experience affect physical functioning and their mental health; age, site of cancer and the interval of time out of treatment influence changes in their symptom experience; and age, site of cancer, the interval of time out of treatment, and changes in symptom experience influence changes in physical and mental health. METHODS: Patients (n = 111) who completed an intake and a 6-month self-administered questionnaire were included. Treatment included chemotherapy, radiation, or hormonal treatment at intake and for 6 months. Scales of nine symptoms and physical health using activities of daily living and measures of vigorous function were composed. Mental health was measured by the Center for Epidemiological Studies--Depression Scale. RESULTS: The analyses yielded the following findings: (1) Primary site may have had an impact on symptom experience, limitations in functioning, and mental health if more patients with lung cancer had survived to 6 months. (2) Age, gender, treatment, or change in treatment had no impact on symptoms, functioning, or mental health at intake or changes in these variables. (3) Symptom experience at intake and the changes in symptoms predicted physical functioning and mental health at intake and the changes in these variables over time. (4) Gender differences were important in predicting mental health. CONCLUSIONS: Strategies for continuing care and rehabilitation need to focus on symptom management, and strategies need to be different for male and female patients.

Activities of Daily Living↗
PubMed1994

Strategies to meet the needs of the rural poor.

Demographic, geographic, and economic forces have influenced the treatment and supportive care of patients with cancer and their families who reside in rural areas. The trends that limit access to cancer care include an aging population, lower income, less comprehensive insurance coverage, ill-equipped and poorly staffed health care facilities, and geographic isolation from health care services. It is important to develop strategies that can be used to overcome the barriers to rural cancer care.

Clinical Competence↗
PubMed1994

Predictors of use of secondary carers used by the elderly following hospital discharge.

This research examines how caregiver-patient relationship (female spouses, and adult daughters and daughters-in-law) when cross classified with patient coresidence patterns explains the level of secondary carers' involvement among patients with newly added needs for assistance at home following hospital discharge. Among 196 primary caregivers (104 spouses, 92 daughters and daughters-in-law), patient needs were divided into ADL and mobility limitations, and medical tasks. Secondary carer involvement was categorized into levels differing at two observations: one following discharge and a second 3 months later. Analyses focused on explaining the levels of involvement of secondary carers following hospital discharge and the changes in secondary carers' involvement between the two observations. The baseline and change analyses revealed that caregiver-patient relationship was more important than coresidence patterns or patients' demands in explaining assistance from secondary carers. The implications of these findings on caregivers' reactions and policies regarding home care are explored.

Aged↗
PubMed1994

Family home care for individuals with cancer.

Cancer care has, to a great extent, shifted to outpatient and home settings, placing more responsibility for such care on the family members. Home care encompasses a wide range of patient needs, including symptom management, monitoring and use of equipment, medical care tasks related to surgery, coordination of care, and monitoring and evaluation of key health status parameters, as well as assistance with self-care and instrumental activities. Different families organize care tasks in different ways. By understanding how a particular family responds and organizes to fulfill patient care needs, health-care professionals will have a basis upon which to construct a plan of care in partnership with the patient and family members. This article describes home care issues from the perspectives of the patient and family members, and proposes strategies that health-care professionals can use to improve the outcomes of supportive care for the patient and family.

Caregivers↗
PubMed1993

The cost of cancer home care to families.

BACKGROUND: For the most part, previous research on costs of cancer care has focused on the formal medical care costs. Research on home care for patients with cancer has emphasized direct care costs (expenditures). Among indirect costs, only loss of income to family members has been studied. However, a major component of indirect costs, the family labor expended to care for the patient with cancer, needs to be included for a more realistic appreciation of home care costs. METHODS: The costs of family labor are estimated by imputing monetary values for the time spent caring for the patient with cancer. The assigned monetary cost either is equated with income losses of the helper in question or is based on a putative market value of the expended labor time. In addition, out-of-pocket expenditures examined in this study cover all cancer care-related expenses for which the patient was not reimbursed by third parties. Data were obtained from a convenience sample of 192 patients with cancer and their families in lower Michigan. RESULTS: When family labor is included in the cost calculations, average cancer home care costs for a 3-month period ($4563) are not much lower than the costs of nursing home care. The substantial variation in home care costs (standard deviation [SD] = $4313) appears to be unrelated to the type of cancer diagnosis, type of treatment, or time since diagnosis but seems to be driven by the functional status of the patient and the family living arrangements. CONCLUSIONS: Outpatient care for patients with cancer coupled with greater reliance on home care appear to be economically attractive because costs to families usually are underestimated.

Adult↗
PubMed1993

Gender bias in the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D).

Confirmatory factor-analytic models are used to examine gender biases of individual items of the Center for Epidemiologic Studies Depression (CES-D) Scale. In samples containing 708 cancer patients and 504 caregivers of the chronically ill elderly, two CES-D items are identified as producing biased responses in comparisons of male and female respondents. Three additional CES-D items are excluded on the basis of other psychometric problems, yielding a subset of 15 CES-D items that capture almost all the information of the original 20-item CES-D scale but are free of any gender bias. Gender differences in mean levels of depressive symptomatology are significantly reduced, but not eliminated, when the 15-item scale is used.

Activities of Daily Living↗
PubMed1993

The influence of cancer patients' symptoms and functional states on patients' depression and family caregivers' reaction and depression.

In this article the paths among cancer patients' physical and mental health and the reactions and mental health of their family caregivers were examined. Data for these analyses came from a cross-sectional sample of cancer patients who were recruited through ambulatory outpatient chemotherapy units, and their family caregivers. Patients' depression was explained largely by their symptomatology and, to a lesser extent, by loss of mobility. Patients' physical limitations impacted caregivers' daily schedules but not their physical health. Patients' levels of depression were related to those of their caregivers. However, caregivers' optimism proved to be a significant predictor of their mental health and reactions to caregiving.

Activities of Daily Living↗
PubMed1993

Relationships of barriers and facilitators to breast self-examination, mammography, and clinical breast examination in a worksite population.

The American Cancer Society recommends a regimen for breast cancer screening that includes mammograms, clinical breast examination, and breast self-examination. Compliance with breast cancer screening guidelines has been linked to a number of barriers and facilitators. These barriers and facilitators seem to lie within the cognitive framework and generalized beliefs of women, and in the situational contexts in which they lead their lives. A comprehensive study was designed to investigate variables related to breast cancer screening behaviors (breast self-examination, mammography, and clinical breast examination) of working women > or = 35 years of age at their worksite environments. A factor analysis identified similar sets of composite variables related to each of the screening modalities, and a discriminant analysis was performed for each screening technique to identify those variables that were most significant in predicting compliance with screening guidelines. The variables discomfort, perceived efficacy, and desire for control over health were significant for all three screening behaviors. Perceived importance was identified as a fourth variable for mammography and clinical breast examination, and lack of knowledge was a fourth variable for breast self-examination. Effective breast cancer screening programs involve all three screening techniques. In the design of education and intervention programs at worksites, it is critical to emphasize the commonalities of the variables that emerged in this study as important for each screening technique. Health-care professionals who implement such intervention programs need to explore and bring into the open these common barriers and facilitators to maximize working women's compliance with breast screening guidelines.

Adult↗
PubMed1992

The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairments.

The development and testing of a multidimensional instrument to assess the reactions of family members caring for elderly persons with physical impairments, Alzheimer's disease, and cancer is reported. Forty items were administered to a sample of 377 caregivers of persons with physical impairments and Alzheimer's disease. Five dimensions of caregivers' reactions were identified through exploratory factor analysis. Using confirmatory factor analysis on an independent sample (N = 377), these dimensions were tested for factorial invariance across spouse and nonspouse caregivers and between caregivers of persons with cancer and those caring for persons with Alzheimer's disease. The subscales also had a high level of factorial invariance across a three-wave panel study (N = 185). The subscales appeared consistent with first order tests of construct validity.

Aged↗
PubMed1992

Confirmatory factor analysis (CFA) as a method to assess measurement equivalence.

Employing the example of a multidimensional caregiver reaction scale, the use of confirmatory factor analysis techniques to establish measurement equivalence across comparison groups is discussed. The discussion is organized around the key concept of factorial invariance which provides the yardstick for assessing measurement equivalence.

Alzheimer Disease↗
PubMed1992

Caregivers of elderly relatives: spouses and adult children.

A problem in the provision of home health care for elderly people is the limited number of family members available for caregiving. Current trends in federal, state, and local policy formation suggest an increasing emphasis on the family as an appropriate caregiver. Therefore, it is necessary to examine how family relationships affect the caregivers' responses to their caregiver situation. Data are presented from 206 caregivers enrolled in a larger longitudinal study of family members caring for elderly dependent relatives. The sample is divided into four caregiver groups: (1) spouses who have children, (2) spouses who have no children, (3) adult children who have siblings, and (4) adult children who have no siblings. Measures selected for comparison were perception of burden, caregiver involvement, affective social support, mental health status, and use of community services. Differences were found among the four groups of caregivers. Implications for social work intervention are discussed.

Adult↗
PubMed1991

Knowledge and use of community services among family caregivers of Alzheimer's disease patients.

The number of people with dementia residing within the community is steadily increasing. Community services can alleviate the burdens experienced by families, but are used infrequently by families of dementia patients. Caregivers (N = 93) of dementia patients were surveyed regarding their knowledge and use of community services. The most frequently used services were family support groups and home health aides. Overall, service use was low despite high levels of perceived availability of services. Older and less educated caregivers had higher levels of uncertainty about service availability. Depressed caregivers were less likely to know about service availability. Implications for practice and research are presented.

Age Factors↗