Browsing by Author "Washington, Karla T."
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Item Delivering problem-solving therapy to family caregivers of people with cancer: A feasibility study in outpatient palliative care(Wiley, 2018) Washington, Karla T.; Demiris, George; Oliver, Debra Parker; Albright, David L.; Craig, Kevin W.; Tatum, Paul; University of Missouri Columbia; University of Pennsylvania; University of Alabama TuscaloosaObjective: In response to the well-documented need for evidence-based cancer caregiver support, we examined the feasibility of problem-solving therapy for family caregivers of cancer patients receiving outpatient palliative care and investigated the impact of problem-solving therapy on family caregivers' anxiety, depression, and quality of life. Methods: We conducted a feasibility study of a structured problem-solving therapy intervention delivered to family caregivers of cancer patients receiving outpatient palliative care from an academic health center in the Midwestern United States. Participants (N = 83) were randomly assigned to receive usual care or usual care plus a problem-solving therapy intervention, which was delivered over three sessions via web-based videoconferencing or telephone. Descriptive statistics were used to determine feasibility relative to recruitment, retention, and fidelity to core intervention components. Outcome data were analyzed using ordinary least squares multiple regression. Results: Problem-solving therapy for family caregivers of patients with cancer was found to be highly feasible in the outpatient palliative care setting. Caregivers who received problem-solving therapy reported less anxiety than those who received only usual care (P = 0.03). No statistically significant differences were observed for caregiver depression (P = 0.07) or quality of life (P = 0.06). Conclusions: Problem-solving therapy is a feasible and promising approach to reducing cancer family caregivers' anxiety in the outpatient palliative care setting. Further testing in multiple sites is recommended.Item Gender Differences in Caregiving at End of Life: Implications for Hospice Teams(Mary Ann Liebert, 2015) Washington, Karla T.; Pike, Kenneth C.; Demiris, George; Oliver, Debra Parker; Albright, David L.; Lewis, Alexandria M.; University of Missouri Columbia; University of Washington; University of Washington Seattle; University of Alabama TuscaloosaBackground: Researchers have identified important gender differences in the experience of caring for a family member or friend living with advanced disease; however, trends suggest that these differences may be diminishing over time in response to changing gender roles. In addition, while many studies have found caregiving experiences and outcomes to be poorer among female caregivers, noteworthy exceptions exist. Objective: The primary aim of this exploratory study was to determine how, if at all, current day caregiving at end of life varies by gender. Methods: We conducted a secondary analysis of data from a multisite randomized controlled trial of a family caregiving intervention performed between 2010 and 2014. We compared female and male hospice family caregivers on baseline variables using (2) tests for association of categorical variables and t-tests for continuous variables. Our sample included 289 family caregivers of individuals receiving services from one of two hospice agencies located in the northwestern United States. Demographic data and other categorical variables of interest were provided via caregiver self-report using an instrument created specifically for this study. Reaction to caregiving and caregiving burden were measured using the Caregiver Reaction Assessment (CRA). Results: As it related to caregiving, females had significantly lower self-esteem and more negative impact on their schedule, health, and family support than males. No gender differences were detected with regard to the impact of caregiving on individuals' finances. Conclusions: Despite changing social expectations, pronounced gender differences persist in caregiving at the end of life.Item A multimethod analysis of shared decision-making in hospice interdisciplinary team meetings including family caregivers(Sage, 2016) Washington, Karla T.; Oliver, Debra Parker; Gage, L. Ashley; Albright, David L.; Demiris, George; University of Missouri Columbia; University Nebraska Kearney; University of Alabama Tuscaloosa; University of Washington; University of Washington SeattleBackground: Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. Aim: We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. Design: We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n=100), individual interviews of family caregivers (n=73) and hospice staff members (n=78), and research field notes. Setting/participants: Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Results: Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in healthcare delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. Conclusion: The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers.