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Factors Associated with Family Caregivers' Confidence in Future Surrogate Decision Making for Persons with Cancer.

ABSTRACT: Background: Improving family caregiver preparation for surrogate decision making is a critical priority. Objective: Determine a parsimonious set of intrapersonal factors associated with family caregivers' confidence in making future medical decisions for their relatives with cancer. Methods: Cross-sectional mail survey. Family caregivers of Medicare beneficiaries with pancreatic, lung, brain, ovarian, head and neck, hematologic, and stage IV cancers from communities of eight U.S. cancer centers. Participants completed validated measures of their social and mental health, self-care behaviors, coping styles, and surrogate decision-making confidence. Using linear modeling, the Bayesian information criterion was used to identify factors associated with decision-making confidence. A bootstrap approach was used to conduct penalized inference on the selected model coefficients. Model fit validation was assessed with a random forest ensemble. Results: Caregivers (n?=?294) were on average 65.5 years old, mostly female (72.8%), and care recipients' spouse/partner (60.2%). The parsimonious set of factors associated with low caregiver decision-making confidence included less engagement in spiritual growth self-care, more use of avoidant coping, low emotional social support, and younger care recipient age (in-sample R2?=?0.22). These factors were also identified by a random forest approach. After overfitting adjustment (shrunken R2?=?0.09), the strongest associations with low surrogate decision-making confidence were low spiritual growth self-care (adjusted standardized B?=?0.17, p?=?0.005) and high use of avoidant coping (adjusted standardized B?=?-0.12, p?=?0.049). Discussion: Identifying strategies to enhance spiritual growth and reduce avoidant coping may be promising targets for interventions to improve family caregivers' confidence in future surrogate decision making.

SUBMITTER: Dionne-Odom JN

PROVIDER: S-EPMC6308286 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Factors Associated with Family Caregivers' Confidence in Future Surrogate Decision Making for Persons with Cancer.

Dionne-Odom J Nicholas JN Ejem Deborah D Azuero Andres A Taylor Richard A RA Rocque Gabrielle B GB Turkman Yasemin Y Thompson Moneka A MA Knight Sara J SJ Martin Michelle Y MY Bakitas Marie A MA

Journal of palliative medicine 20180821 12

Background: Improving family caregiver preparation for surrogate decision making is a critical priority. Objective: Determine a parsimonious set of intrapersonal factors associated with family caregivers' confidence in making future medical decisions for their relatives with cancer. Methods: Cross-sectional mail survey. Family caregivers of Medicare beneficiaries with pancreatic, lung, brain, ovarian, head and neck, hematologic, and stage IV cancers from ...[more]

PMID: 30129873

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Project description:ImportanceEngaging in shared decision-making (SDM) can help patients understand and choose treatments according to their values and has been shown to improve patient satisfaction and adherence with treatment. It is well suited for conditions like eczema for which several medically appropriate treatment options exist. However, little is known about the use and experience of SDM in eczema.ObjectiveTo understand experiences, preferences, and expectations for SDM in eczema care settings from the patient and caregiver perspective.Design, setting, and participantsThe National Eczema Association conducted an online survey in January 2021 among self-selected patients and caregivers. Inclusion criteria (US resident, patient with eczema or caregiver of a patient with eczema aged ≤17 years, respondent age ≥18 years) were met by 1313 of 1387 respondents (94.7%). Data analysis was performed from May 2021 to November 2021.Main outcomes and measuresOutcomes were past SDM (using a 9-item SDM questionnaire [SDMQ9]; score ranges transformed to 0-100), present SDM (Control Preferences Scale), and future SDM (self-reported confidence and motivation to engage in SDM) behavior.ResultsAmong the 1313 respondents included in the study, most were female (1046 of 1313 [79.7%]) adult (1086 of 1313 [82.7%]) patients with a mean (SD) patient Recap of Atopic Eczema score of 11.7 (7.2), mean (SD) patient age of 39.5 (22.2) years, and mean (SD) SDMQ9 score of 65.1 (27.4). For present SDM, 479 of 966 (49.6%) reported "I prefer to make the final decision after seriously considering my doctor's opinion," and 655 of 955 (69.4%) reported being very or extremely confident to engage in SDM in the future. Those who reported feeling "very well informed" about the causes of eczema had a 14.7-point higher (95% CI, 9.2-20.2; P < .001, multiple linear regression) SDMQ9 score than those "not adequately informed" and were 3.4 times more likely (95% CI, 2.1-5.7; P < .001, multiple logistic regression) to be confident to engage in future SDM. Respondents reported that they would be motivated to engage in SDM if the clinician initiated SDM, valued input from the patient, and acknowledged that patients are experts on their own bodies or if a treatment is no longer working.Conclusions and relevanceResults of this survey study suggest that a majority of patients with eczema and caregivers prefer a large role in decision-making for their care and that clinicians can initiate and facilitate SDM to improve patient satisfaction with care.

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Factors Associated with Family Caregivers' Confidence in Future Surrogate Decision Making for Persons with Cancer.

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Factors Associated with Family Caregivers' Confidence in Future Surrogate Decision Making for Persons with Cancer.

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