November is Carer Awareness Month and timely findings from a study published in blood progress suggests that, among caregivers of stem cell transplant patients, how someone approaches coping can affect the levels of anxiety, depression and poor quality of life (QOL) they experience. experience. In particular, coping and acceptance strategies appear to be more helpful.
“This study highlights that caregivers’ experiences of psychological distress are real, and how the way caregivers deal with the challenges they face in supporting their loved one affects their level of emotional distress. suffering and their quality of life We also know from previous research that the psychological health of those caregivers- is affected patient results“, Hermioni Amonoo, MD, of the Dana-Farber Cancer Institute, and Carol C. Nadelson, MD, Distinguished Chair in Psychiatry, Brigham and Women’s Hospital in Boston, and the study’s principal investigator.
Most stem cell transplant centers require those preparing for a transplant to designate a primary caregiver—who will support them for the first 100 days after the transplant. In addition, prior to a blood cancer stem cell transplant, most patients receive induction chemotherapy, which effectively suppresses their immune system, making them very sick. susceptible to infections and other medical complications.
Carers have many responsibilities, including taking steps to protect patients from infections due to their highly immunocompromised status, assisting patients to take multiple medications each day, said Dr. Amonoo. day, help patients prepare meals that follow post-transplant instructions, and coordinate communication between the patient and their healthcare team.
“Our research highlights the urgent need for resources to help caregivers of patients develop and use coping strategies to protect their mental health and quality of life, and help them fulfill this important role,” she said.
Previous studies have shown that caregivers of cancer patients experience distress, loneliness, fatigue, sleep disturbances, financial anxiety and poor QOL, and fatigue in caregivers The care of patients receiving a stem cell transplant is associated with slower growth of new healthy blood cells and poorer sleep quality for patients. Dr Amonoo took this research a step further by specifically studying the impact of different coping styles on caregivers and their loved ones.
“This is the largest study to date to examine caregiver coping strategies,” said Dr. Amonoo. “The whole area of carer research is very new,” she says.
Researchers in this field classify caregiver coping strategies into two broad categories called “avoidance” and “directed approach”. Avoidance coping strategies include denial of the reality of the situation and self-blame, in which caregivers blame themselves if a patient misses a dose or is late for an appointment. In contrast, approach-oriented coping strategies include positive problem solving, finding emotional support, and using “positive adjustment” to think about their situation in a different way.
For this study, Dr Amonoo and her colleagues enrolled 170 primary caregivers for people with the disease. blood cancer people who have undergone a stem cell transplant. A carer can be a spouse, relative, or friend whom the patient identifies as their primary caregiver. Most caregivers were female (130, or 76.5%) and white (147, or 86.5%); Their average age is 53.
Immediately after the patient was admitted to the hospital for a stem cell transplant, caregivers completed questionnaires about their use of different coping strategies, symptoms of anxiety or depression, and QOL. The researchers also looked at caregivers’ dependence on religious beliefs as a coping strategy.
A significant number of caregivers reported using multiple coping strategies such as acceptance (55.9%), positive adjustment (45.9%), and religion (44.1%). Caregivers who relied on approach-oriented coping strategies such as these (49.4%) had fewer symptoms of anxiety and depression and better QOL than those who relied on coping strategies dodge (32.9%).
“Strategies such as positive problem solving and positive adjustment appear to be more helpful for caregivers than strategies such as denial and self-blame,” said Dr. Amonoo. “In this study, we found no link between religious coping strategies and caregiver distress or QOL, although several previous smaller studies have found associations such as so.”
She adds: “Coping strategies are neither good nor bad — you have to meet people where they are.
“And caregivers can be taught to use coping strategies that can be more helpful and can help them feel less anxious, depressed or overwhelmed. So if one carer If people are thinking, ‘My life will never be the same again’, we can help them reframe that thinking in a more positive way—for example, ‘I know there’s a lot of uncertainty when people My body recovers from trauma stem cell transplantbut I’m not alone in this—I can talk to the care team when I have a question or when I feel inadequate about something I need to do.'”
Dr Amonoo said her research team is working on developing a variety of interventions and resources for caregivers. “Our goal is to create resources that help caregivers succeed while helping them take care of their own mental health,” she says.
Hermioni L. Amonoo et al., Dealing with caregivers of patients with hematological malignancies receiving hematopoietic stem cell transplants, blood progress (2022). DOI: 10.1182/health advance.2022008281
American Society of Hematology
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