scholarly journals 202 - Music Therapy Intervention to Reduce Caregiver Distress at End of Life: A Feasibility Study

2021 ◽  
Vol 33 (S1) ◽  
pp. 7-7
Author(s):  
Kevin Whitford ◽  
Angela Ulrich ◽  
Travis Dockter ◽  
Brianna E. Larsen ◽  
Christina Wood ◽  
...  
Keyword(s):  
Music Therapy ◽  
End Of Life ◽  
Hospice Care ◽  
Positive Impact ◽  
Spiritual Support ◽  
Depression And Anxiety ◽  
Anticipatory Grief ◽  
Therapy Program ◽  
Patient Health ◽  
The Impact

ContextMusic therapy is frequently provided to patients at the end of life, and studies have shown a benefit in relief of symptoms and a positive impact on quality of life (QoL), but little is known regarding the effect of music therapy (MT) on caregivers. Caregivers are at risk for anxiety, emotional distress and experience anticipatory grief as the patient nears death. Caregivers are present with patients and may also benefit from MT.ObjectiveTo assess the impact of MT on caregivers for hospice patients and determine the feasibility of research in this population.MethodsTwenty caregivers of patients hospitalized for general inpatient hospice care were enrolled. MT was provided by a board-certified music therapist, and sessions included pre-MT assessment, 20-45 minutes of MT, and post-MT assessment. Caregiver stress was measured with the Pearlin Role Overload Measure (ROM), QoL was measured with the Linear Analogue Self-Assessment (LASA), and depression and anxiety were measured with the Patient Health Questionnaire for Depression and Anxiety (PHQ-4). These three measures were taken pre-MT, post-MT and 6 months post-MT. Caregivers were also asked to complete a Music Therapy Program Survey post-MT.ResultsThe MT intervention was completed for 15/20 caregivers (75%). Of those who did not complete MT, 2 withdrew prior, 1 was not available, 1 patient passed during the MT session, and 1 patient died prior to MT. 14 caregivers completed pre-MT and post-MT assessments, and 9 caregivers completed assessments at all 3 timepoints. The MT Program Survey (post-MT assessment, n=14) showed 100% of caregivers were very satisfied with MT and would recommend to others, 78% found MT effective for stress relief, 69% for relaxation, 71% for spiritual support, 86% for emotional support, and 71% for feeling of wellness.ConclusionResearch on MT is feasible for acute hospice care caregivers with a majority of caregivers consenting to research and about half completing surveys pre-MT, post-MT, and 6-months post-MT (9/20). Future larger studies should be conducted to better assess the impact of MT on caregivers.

Outpatient Palliative Care and Aggressiveness of End-of-Life Care in Patients with Metastatic Colorectal Cancer

2017 ◽  
Vol 35 (1) ◽  
pp. 166-172 ◽  
Author(s):  
Si Won Lee ◽  
Hyun Jung Jho ◽  
Ji Yeon Baek ◽  
Eun Kyung Shim ◽  
Hyun Mi Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Department ◽  
Palliative Care ◽  
Metastatic Colorectal Cancer ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Emergency Department Visits ◽  
Life Care ◽  
The Impact

Background: Palliative care in outpatient setting has been shown to promote better symptom management and transition to hospice care among patients with advanced cancer. Nevertheless, specialized palliative care is rarely provided at cancer centers in Korea. Herein, we aimed to assess aggressiveness of end-of-life care for patients with metastatic colorectal cancer according to the use of outpatient palliative care (OPC) at a single cancer center in Korea. Methods: We performed a retrospective medical record review for 132 patients with metastatic colorectal cancer who died between 2011 and 2014. Fifty patients used OPC (OPC group), while 82 patients did not (non-OPC group). Indicators of aggressiveness of end-of-life care including chemotherapy use, emergency department visits, hospitalization, and utilization of hospice care were analyzed according to the use of OPC. Results: More patients in the OPC group were admitted to hospice than those in the non-OPC group (32% vs 17%, P = .047). The mean of inpatient days within 30 days of death was shorter for the OPC group than the non-OPC group (4.02 days vs 7.77 days, respectively, P = .032). There were no differences in the proportions of patients who received chemotherapy and visited the emergency department within 30 days from death. Conclusion: Among patients with metastatic colorectal cancer, OPC was associated with shorter inpatient days near death and greater hospice utilization. Further prospective studies are needed to evaluate the impact of OPC on end-of-life care in Korea.

scholarly journals Digital Cognitive Behavior Therapy Intervention for Depression and Anxiety: Retrospective Study (Preprint)

2020 ◽  
Author(s):  
Aarathi Venkatesan ◽  
Lily Rahimi ◽  
Manpreet Kaur ◽  
Christopher Mosunic
Keyword(s):  
Mental Health ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Behavioral Therapy ◽  
Severe Depression ◽  
Cognitive Behavior ◽  
Depression And Anxiety ◽  
Point Reduction ◽  
Therapy Program ◽  
Patient Health

BACKGROUND Digital mental health interventions offer a scalable solution that reduces barriers to seeking care for clinical depression and anxiety. OBJECTIVE We aimed to examine the effectiveness of a 12-week therapist supported, app-based cognitive behavioral therapy program in improving symptoms of depression and anxiety within 9 months. METHODS A total of 323 participants with mild to moderately severe depression or anxiety were enrolled in a 12-week digital cognitive behavior therapy program. The analysis was restricted to participants who provided at least one follow-up assessment after baseline. As a result, 146 participants (45.2%) were included in the analysis—74 (50.7%) participants completed assessments at 3 months, 31 participants (21.2%) completed assessments at 6 months, and 21 participants (14.4%) completed assessments at 9 months. The program included structured lessons and tools (ie, exercises and practices) as well as one-on-one weekly video counseling sessions with a licensed therapist for 12 weeks and monthly check-in sessions for 1 year. The clinically validated Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety, respectively. Linear mixed-effects modeling was employed to examine changes in depression and anxiety over time. RESULTS We observed a significant positive effect of program time on improvement in depression (β=–0.12, <i>P</i>&lt;.001) and anxiety scores (β=–0.10, <i>P</i>&lt;.001). At the end of the 12-week intervention, we observed an average reduction of 3.76 points (95% CI –4.76 to –2.76) in PHQ-8 scores. Further reductions in depression were seen at program month 6 (4.75-point reduction, 95% CI –6.61 to –2.88) and program month 9 (6.42-point reduction, 95% CI –8.66 to –6.55, <i>P</i>&lt;.001). A similar pattern of improvement emerged for anxiety, with a 3.17-point reduction at the end of the 12-week intervention (95% CI –4.21 to –2.13). These improvements were maintained at program month 6 (4.87-point reduction, 95% CI –6.85 to –2.87) and program month 9 (5.19-point, 95% –6.85 to 4.81). In addition, greater program engagement during the first 12 weeks predicted a greater reduction in depression (β=–0.29, <i>P</i>&lt;.001) CONCLUSIONS The results suggest that digital interventions can support sustained and clinically meaningful improvements in depression and anxiety. Furthermore, it appears that strong initial digital mental health intervention engagement may facilitate this effect. However, the study was limited by postintervention participant attrition as well as the retrospective observational study design.

scholarly journals Hospice Care for Veterans: A Community Education Program

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 777-777
Author(s):  
Denise Kresevic ◽  
Barbara Heath ◽  
Muralidhar Pallaki
Keyword(s):  
Vietnam Veterans ◽  
Hospice Care ◽  
Community Education ◽  
Moral Injury ◽  
Telemental Health ◽  
Spiritual Support ◽  
Care Providers ◽  
Continued Education ◽  
Assessment Skills ◽  
The Impact

Abstract The impact of trauma on care at end of life and the social isolation of the COVID-19 pandemic highlighted a critical gap in care of terminally ill veterans. It is estimated that 30% of Vietnam Veterans suffer from PTSD, suicide rates are 49% higher in older veterans than nonveterans, and 41% of veterans surveyed report post traumatic guilt. A survey of non-VA hospice agencies revealed many do not screen for PTSD, but desired training in this area. The VA responded to these challenges implementing an initiative to educate community caregivers on PTSD, suicide, and moral injury with expanded tele mental health services. Several VA sites were supported to participate in training focusing on PTSD, suicide, and moral injury and Telemental health. In Northeast Ohio, from 2019-20, 11 community hospice agencies participated in training, including 283 providers,120 (42%) nurses, 100 (35%) social workers, 29 (10%) volunteers, and 34 (12%) other. A majority of participants post-training (n=160) (84%-94%) reported enhanced knowledge, skills, or attitudes related to resources, education, and communication. Participants rated changes for assessment skills lowest for moral injury (34%), PTSD (41%), and suicide (56%). An analysis of telemental health visits (N=50) revealed that, 56% addressed spiritual support, (22%) family support, (10%) resources/referrals, and (8%) confusion. The majority of telehealth visits were VA initiated (84%), and 10% were hospice initiated Continued education regarding PTSD, suicide, and moral injury assessment skills is still needed for hospice care providers of veterans. These findings support the use of telemental health for care and consultation.

The Impact of Hospice on Mortality of Widowed Spouses (DRAFT)

2018 ◽  
Author(s):  
Kimberson Tanco ◽  
Regina Mackey
Keyword(s):  
Social Support ◽  
End Of Life ◽  
Mortality Risk ◽  
Symptom Management ◽  
End Of Life Care ◽  
Hospice Care ◽  
Family Satisfaction ◽  
Life Care ◽  
Advanced Illness ◽  
The Impact

Caring for a sick spouse can have adverse health consequences and may increase mortality for the surviving spouse. This can be associated to a caregiver and widow/er effect, which may be related to the loss of beneficial social support and impact of stress from the advanced illness and death of the spouse. This study explores if the nature of end-of-life care that the decedent spouse received might be associated with the mortality risk of the surviving spouse. This is preceded by the hypothesis that “good deaths” may result in less stress on the families. At the same time, it is presumed that hospice care facilitates “good deaths” by optimizing symptom management, enables home deaths, and may enhance patient and family satisfaction.

scholarly journals THE EXAMINATION OF DETERMINANTS AND BARRIERS TO END-OF-LIFE DECISION MAKING AND PLANNING

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S236-S237
Author(s):  
Brittany E Gaines ◽  
Debra J Dobbs
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
End Of Life ◽  
Rural Areas ◽  
Hospice Care ◽  
Service Providers ◽  
Advance Care ◽  
End Of Life Decision ◽  
The Impact

Abstract As individuals are living longer, in many cases with chronic diseases, there is an increased focus on end-of-life (EOL) planning and decision making. This includes a broad spectrum of choices including advance care planning (ACP) and turning to palliative care or hospice care. Although there has been an increase in palliative and hospice care enrollment and ACP engagement over the past decade, participation remains low for certain subgroups of the population. The purpose of this symposium is to offer insight into reasons for these varying rates of engagement by exploring determinants and barriers to EOL decision making and planning and by examining caregiver knowledge of EOL decision making and planning from the service provider perspective. The first three studies examine various types of influences in EOL decision making and planning. Inoue and colleagues explore factors associated with the length of hospice stay, and Gaines and colleagues examine the impact of environmental characteristics in ACP. Ornstein and colleagues use Denmark registry data to assess the role of kinlessness at the time of death in EOL decision making and healthcare utilization. The final presentation by Noh and colleagues examines how service providers in rural areas perceive community residents’ knowledge of ACP and palliative care. The discussion following these presentations will compare findings across different forms of EOL decision making and planning, consider the impact of the varying methodological approaches used, and highlight implications of these works for potential interventions and policies related to EOL decision making and planning.

Attitudes and Perceptions of End-of-Life Dreams and Visions and Their Implication to the Bereaved Family Caregiver Experience

2020 ◽  
pp. 104990912095231
Author(s):  
Pei C. Grant ◽  
Kathryn Levy ◽  
Tahleen A. Lattimer ◽  
Rachel M. Depner ◽  
Christopher W. Kerr
Keyword(s):  
Focus Group ◽  
End Of Life ◽  
Ad Hoc ◽  
Hospice Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Positive Attitudes ◽  
Dreams And Visions ◽  
Bereaved Family ◽  
The Impact

Background: While the majority of research assesses the impact of end-of-life dreams and visions (ELDVs) on patients, more recent research has begun to explore their impact on family caregivers (FCG). Objective: This study evaluates the relationship between general attitudes about dreams, perspectives of ELDV and their role the bereaved FCG experience. Design: Mixed-methods using a cross-sectional survey and five focus groups. Settings/Subjects: A total of 500 FCGs of patients who died under hospice care were recruited for the survey. Focus group members were self-selected through identified interest from the survey. Measurements: In addition to demographics and ELDV prevalence, general attitude toward dreams, ELDV perspectives, and impact on grief were assessed using ad hoc surveys. Results: Participants reporting ELDVs were significantly more validating of everyday dreams ( p < .001). Positive attitudes toward dreams strongly correlated with comfort from ELDVs for both patients and FCGs. Openness correlated positively with comfort from the ELDV for both the patient ( r = .149, p = .038) and FCG ( r = .217, p = 0.002) and negatively with fear/anxiety ( r = −.141, p = 0.050). Negative ELDV perceptions (ex. ELDVs were caused by medications) affected grief in areas such as accepting the loss ( r = −.235, p = .010) or maintaining connection ( r = −.255, p = .010) with the deceased. Focus group discussions were thematically analyzed resulting in 4 themes: ELDV narrative, Connection, Reflection, and Other Experiences. Conclusions: Positive general attitudes toward dreams and positive ELDV perceptions are correlated with better bereavement outcomes. Therefore, patient and family education on ELDVs that focuses on awareness and understanding of ELDVs may enhance clinical outcomes for both family and patients.

scholarly journals Improving Care Experiences for Patients and Caregivers at End of Life: A Systematic Review

2020 ◽  
Vol 38 (1) ◽  
pp. 84-93
Author(s):  
Denise D. Quigley ◽  
Sara G. McCleskey
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Systematic Reviews ◽  
End Of Life Care ◽  
Hospice Care ◽  
Grey Literature ◽  
Research Approach ◽  
Spiritual Support ◽  
Life Care ◽  
Care Plans

Background: End-of-life care is increasing as the US population ages. Approaches to providing high-quality end-of-life care vary across setting, diseases, and populations. Several data collection tools measure patient and/or caregiver care experiences at end of life and can be used for quality improvement. Previous reviews examined palliative care improvements or available measures but none explicitly on improving care experiences. We reviewed literature on improving patient and/or caregiver end-of-life care experiences. Design: We searched U.S. English-language peer-reviewed and grey literature after 2000 on adult end-of-life care experiences. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for quantitative studies, Enhancing Transparency in Reporting the Synthesis of Qualitative Research approach for qualitative studies, and Assessment of Multiple Systematic Reviews tool for the literature reviews. Setting: Palliative and hospice care. Population: Full-text abstraction of 84 articles, identifying 16 articles. Measures: Patient and/or caregiver end-of-life care experiences (captured through administrative data or direct report). Results: Articles examined palliative care experiences across settings; none studied hospice care experiences. Patients and/or caregivers assessed overall care experiences, clinician–staff interactions, provider communication, respect and trust, timeliness of care, spiritual support, caregiver knowledge of care plans, or bereavement support. Efforts aimed at improving end-of-life care experiences are limited and show mixed results. Conclusions: Literature on improving patient and/or caregiver end-of-life care experiences is emerging and focused on palliative care experiences. Evidence on improving hospice care experiences is lacking. Research on strategies for improving end-of-life care experiences should go beyond overall care experiences to include specific aspects of palliative and hospice care experiences.

scholarly journals The COVID States Project#54: Mental health in the United States

2021 ◽  
Author(s):  
Roy H. Perlis ◽  
Jon Green ◽  
Matthew D Simonson ◽  
David Lazer ◽  
Matthew Baum ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
New York ◽  
Major Depression ◽  
New York Times ◽  
The United States ◽  
Economic Stress ◽  
Depression And Anxiety ◽  
Patient Health ◽  
The Impact

With rapid progress toward vaccination in the United States along with falling COVID-19 case rates and a reopening economy, federal and state leaders speak optimistically about a return to normalcy this summer. But as cases diminish, have the unprecedented rates of depression and anxiety documented in our reports, and in other US surveys, also begun to normalize? On the one hand, as a recent New York Times op-ed notes, people in general are remarkably resilient. And in our prior work we showed that depression and anxiety were tied closely to economic stress; as the economy improves, we might expect mental health to improve as well. On the other hand, the impact of a year of COVID-19 quarantine and fear of illness – perhaps compounded by political and societal turmoil – might not resolve so readily.In this report, we characterize rates of depression, anxiety, and sleep disturbance, as we have done on a regular basis since May 2020. We used a standard screening measure drawn from primary care, the Patient Health Questionnaire-9 (PHQ-9), which asks about the symptoms of major depression, as well as 2 items that ask about anxiety (the Generalized Anxiety Disorder-2, or GAD-2). We define major depression as a score on the PHQ-9 of 10 or greater, or moderate depression, often the point at which an individual would be referred for treatment. Sleep disruption and thoughts of suicide are defined based on items on the PHQ-9.

scholarly journals Parents' Voices Supporting Music Therapy within Pediatric Palliative Care

2005 ◽  
Vol 5 (3) ◽  
Author(s):  
Kathryn Lindenfelser
Keyword(s):  
Palliative Care ◽  
Music Therapy ◽  
End Of Life ◽  
Hospice Care ◽  
Terminally Ill ◽  
Children And Families ◽  
Therapy Services ◽  
Hospice And Palliative Care ◽  
The University ◽  
Parents Experiences

It has been my experience that parents are willing and open to express their voices to promote and advocate for music therapy services for their terminally ill children. By listening to parents' voices when providing care for terminally ill children, much can be done to ease the suffering of children and families at the end of life (Widger & Wilkins, 2004). My music therapy masters research at the University of Melbourne with Dr. Katrina McFerran will investigate bereaved parents' experiences of music therapy with their terminally ill child. This inquiry unfolded through my music therapy work with several children and families within hospice and palliative care. Parents have reflected that music therapy was a vital component in their child's care at the end of life. As one mom commented, "I don't care what anyone says, it has made a world of a difference." In order to further explore parents' experiences of music therapy, in-depth interviews will be conducted and transcripts will be analyzed using phenomenological strategies. It has been reported that parents find the interview process helpful in working through grief. They have also reported feeling an overall eagerness to share their child's story in order to provide input that might assist other families in the future (Widger & Wilkins, 2004). This article will describe pediatric palliative and hospice care, discuss parents as advocates for their terminally ill children, portray the use of music therapy within pediatrics, and share an example of music therapy with Jack.

scholarly journals Depression and anxiety before and during the COVID-19 lockdown: a longitudinal cohort study with university students

2021 ◽  
Author(s):  
Virgínia da Conceição ◽  
Inês Rothes ◽  
Ricardo Gusmão ◽  
Henrique Barros
Keyword(s):  
Mental Health ◽  
University Students ◽  
Longitudinal Research ◽  
Depression Symptoms ◽  
Depression And Anxiety ◽  
Portuguese Version ◽  
Increased Risk ◽  
Patient Health ◽  
The Mean ◽  
The Impact

AbstractBackgroundFor young people, just as in the general population, COVID-19 caused many changes in their lives, including an increased risk for mental illness symptoms. We aimed to study the impact of the COVID-19 pandemic in anxiety and depression symptoms in a cohort of university students.MethodsThis study is part of broader longitudinal research on university students’ mental health with data of the Portuguese version of The Patient Health Questionnaire (PHQ-9) and the Portuguese version of the Generalised Anxiety Disorder (GAD-7) with evaluations on January, May and October 2019 and June 2020, as well as socio-demographic information.Results341 university students (257 females and 84 males) were included, with a mean age of 19.91 (SD=1.58). In June 2020, the mean for perceived wellbeing loss was 60.47% (SD=26.56) and 59.54% (SD=28.95) for mental health loss. The proportion of students with scores equal to or above 15 in the PHQ-9 ranged between 22.6% and 25.5% in 2019 and 37.0% in June 2020. The proportion of GAD-7 scores above cut-off ten ranged between 46.0% and 47.8% in 2019 and 64.5% in 2020. Compared with preceding trends, PHQ-9 scores were 3.11 (CI=2.40-3.83) higher than expected, and GAD-7 scores were 3.56 (CI=2.75-5.37) higher.DiscussionCOVID-19 impacted negatively depressive and anxiety symptoms, confirming previous studies and young people’s vulnerability in such uncertain times.

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