Breastcancer Caregiver

1 INDIVIDUAL TOPIC SEARCH STRATEGY (ITSS) GUIDELINES PURPOSE • The purpose of this initial paper is to briefly describe your search strategies when identifying two articles that pertain to an evidence-based practice topic of interest. Course Outcomes This assignment enables the student to meet the following course outcomes. • CO 1: Examine the sources of knowledge that contribute to professional nursing practice. (PO #7) • CO 2: Apply research principles to the interpretation of the content of published research studies. (POs #4 and #8) DUE DATE • Week #2, Jan 17, Sunday, 11:59 PM submitted in ITSS in CANVAS • The college’s Late Assignment policy applies to this assignment. POINTS POSSIBLE: 160 Points. REQUIREMENTS/PREPARING THE PAPER • Each student will sign-up for a group to formulate an evidence-based practice topic of interest • Each group will formulate research question using PICO format – Quantitative study – what are the intervention to improve qualitative life promote among family care givers?(Research quest) • Each group member will search, retrieve, and receive approval for 1 PRIMARY DATA ARTICLE to answer the group Research Question. • Paper should include a Title and Reference pages. • Page Length: 3-4 pages Excluding Title and Reference pages • The paper will include the following: ▪ Clinical Question ▪ Describe problem ▪ Overview/Significance of problem in terms of outcomes or statistics ▪ Your PICOT question ▪ Purpose of your paper ▪ Level of Evidence ▪ Type of question asked ▪ Best evidence found to answer question ▪ Search Strategy ▪ Search terms ▪ Databases used: Chamberlain Database ▪ Refinement decisions made ▪ Identification of most relevant article ▪ Format ▪ Correct grammar and spelling ▪ Use of headings for each section ▪ Use of APA format (7th edition) • Required to write the paper based on PAPER FORMAT • Refers to Grading Rubric in page 3 PLAGIARISM: “Turnitin” Percentage • Less than 25 percentage: Acceptable percentage. • Turnitin Draft Submission Box 2 ▪ Submit your draft of paper into Turnitin Draft Submission Box to check your percentage as many times as needed before you submit your final paper to designated Unit. • If your Final paper has 25% or higher percentage, you must revise/modify your paper contents BEFORE you submit your paper due date and time. • If your Final paper has 25% or higher percentage AT/AFTER you submit your final paper due date and time, Academic Integrity Violation Procedures will be initiated Academic Integrity Violation Procedure • Academic Integrity Violation letter will be sent to student • Assignment Grade will be 0 point • The violation case will be reviewed, and a further sanction will be determined by the Administrators. 3 Clinical Question Research Question • Accurately and clearly states your research question using PICO format Overview of the Problem • See provided guidelines for required elements (i.e. facts & figures, clinical problems in general …etc.) Significance of the Problem • See provided guidelines for required elements (i.e. specific problems related to topic, rationale for obtaining new EBP…. Etc.) Purpose of Paper • Describe the purpose of topic search strategy (ITSS) paper Search Strategy Search Terms • List all terms used to search for your article (i.e. breast cancer, screening, mammography, intervention, assessment, influencing factors….etc.) Library Databases • List Chamberlain library database used (i.e. EBSCO, Medline, OVID, PubMed….etc.) • Google search engine is NOT the library database Availability of Articles • How many research articles were available to answer your research question? • Provide numbers of articles, NOT just saying “plenty, sufficient, many…etc. Refinement Decisions • What decision(s) have changed from your original search strategies? (i.e. peer-review, within last 5 years, primary data article, full-text….etc.) Breastcancer Caregiver

• What was your rationale for your decision to change from original search strategies? Final Article • Describe decisions you made to specifically select 1 PRIMARY DATA ARTICLE as relevant for answering your Research Question Level of Evidence Addresses Topic/Relevance to PICO • Describe how article addresses the topic, purpose, and key points Evidence Level Pyramid • Identify and describe the level of evidence based on Evidence Level/Hierarchy Pyramid • Refers to Handout (Quick Guide to Designs in an Evidence Hierarchy) Study Type • Identify study type of article: Quantitative, Qualitative, or Mixed-Method Study 4 Grading Rubric & Description for Individual Topic Search Strategy Clinical Question (45) Research Question 15 Accurately and clearly states your Research Question as formulated and stated in PICO format (PICO) Purpose of Paper 10 Describe the purpose of your ITSS paper Overview of Problem 10 Describe problem in general (i.e. facts & figures, clinical problems in general …etc.) Significance of Problem 10 Describe specific problems related to topic, rationale for obtaining new EBP…. Etc.) Search Strategy (65) Search Terms 10 List terms used to search for your articles (breast cancer, screening, mammography, intervention, factors, etc.) Library Databases Availability of Articles Refinement Decisions Final Article Relevance to PICO Evidence Level Pyramid Study Type Format Total Points: 10 List Chamberlain library database you used (i.e. EBSCO, Medline, OVID, PubMed) Google search engine is NOT the library database 5 How many research articles were available to answer your research question? Provide numbers 10 As you did your search, what decisions did you make in refinement to get your required articles down to a reasonable number for review? 5 What was your rationale for your decision to change? 5 How many research articles were available to answer your research question after your refinement process? 10 Describe decisions you made to specifically select ONE PRIMARY DATA ARTICLE as relevant for answering your Research Question 10 Submit a copy of selected article. Level of Evidence (20) 10 Describe how the article addresses the topic (i.e. therapy, intervention, prognosis, risk factors, assessments, or meanings.. etc) 5 Identify and describe the Level of Evidence based on level of evidence pyramid (see handout) 5 Identify the study type based on the study design: Quantitative, Qualitative, Descriptive, Mixed-Method Study Format (30) 5 Use of required Headings and Subheading for each category 10 APA Format (7th ed.) references, citations 10 Correct grammar and spelling 5 Paper length (3-4 pages) /160 Points European Journal of Oncology Nursing 38 (2019) 85–91 Contents lists available at ScienceDirect European Journal of Oncology Nursing journal homepage: www.elsevier.com/locate/ejon Effects of a psychosocial intervention on the quality of life of primary caregivers of women with breast cancer T Israel Olatunji Gabriela,b, Pat M. Mayersc,∗ a School of Post Basic Nursing Programmes (Anaesthesia), Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria Division of Nursing and Midwifery, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, South Africa c Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, South Africa b A R T I C LE I N FO A B S T R A C T Keywords: Breast cancer Caregiver burden Nigeria Psycho-education intervention Psychosocial Quality of life Purpose: Breast cancer is the leading form of cancer among women in Nigeria. The care of such patients has shifted from hospital-based care to home and community care, with the resultant increase in responsibility and burden on caregivers. The study aimed to implement and evaluate the effectiveness of a psychosocial intervention programme on the quality of life (QOL) and caregiver burden of the primary caregivers of women with breast cancer. Method: This was a quasi-experimental study with 108 primary caregivers (54 in both intervention and control groups). The intervention comprised six 90-min educational sessions, held weekly. Breastcancer Caregiver

Topics included information about breast cancer, the emotional aspect of caring, adjustment to the role of caregiver and communication strategies. The intervention group received the psychosocial intervention programme in addition to routine care, and the control group received routine care. Primary outcome (caregiver burden) and caregiver QOL were measured using the Zarit Burden Interview (ZBI) and Caregiver Quality of Life Index-Cancer (CQOLC) at baseline, week six and week 12. Results: The psychosocial intervention reduced caregiver burden at both T1 and T2 (p = 0.000, p = 0.018 respectively) and improved the caregiver QOL (p = 0.000, p = 0.020 respectively) in the intervention group compared to the control group. Conclusion: The psychosocial intervention programme had a positive effect on caregiver burden and QOL. Issues such as sustainability of such programmes and advocacy relating to caregiver burden need further research. 1. Introduction Breast cancer is the leading form of cancer among women in Nigeria, affecting primarily women over 40 years of age (Ntekim et al., 2009). The incidence of the disease has risen significantly between 1960 and 2010 in Nigeria; from 13.7 per 100000 in 1960–1969 to 54.3 per 100000 between 2009 and 2010 (Jedy-Agba et al., 2012). Although there is an increased incidence of breast cancer, diagnosis and management has also improved, with the majority of patients in developed countries remaining alive five years after diagnosis (Youlden et al., 2012). Another development in breast cancer management is the shift from the acute care cancer centre (hospital in-patient care) to outpatient and community settings for continued care (Northouse, 2012; Wadhwa et al., 2013). Consequently, the burden of care has shifted from health workers to family members, who often serve as primary caregivers (Frambes et al., 2018). ∗ Primary caregivers have assumed many of the care roles and functions of hospital-based health workers; this includes involvement in treatment planning, decision making and implementing ongoing treatment and care at home (Lkhoyaali et al., 2015; Waldron et al., 2013). Many caregivers are ill-prepared for the caregiving role and have limited knowledge which may impact on the nature and quality of care provided (Chih et al., 2013; Northouse, 2012). In caring for their family member, caregivers often neglect their own health care needs (Lapid et al., 2016), with risk of a deterioration in their own quality of life (QOL). Hodges et al. (2005) reported that there was a significant relationship between the distress reported by cancer patients and the distress reported by their caregivers; distress of the cancer patient is shared by the caregiver. Although research into the QOL of primary caregivers of women with breast cancer has been conducted worldwide (McMillan et al., 2006; McMillan and Small, 2007; Wadhwa et al., 2013; Waldron et al., Corresponding author. E-mail addresses: israelchristson@gmail.com (I.O. Gabriel), pat.mayers@uct.ac.za (P.M. Mayers). https://doi.org/10.1016/j.ejon.2018.12.003 Received 10 April 2018; Received in revised form 6 December 2018; Accepted 10 December 2018 1462-3889/ © 2018 Elsevier Ltd. All rights reserved. European Journal of Oncology Nursing 38 (2019) 85–91 I.O. Gabriel, P.M. Mayers 2.1. Control group 2013), research into this aspect of care in Nigeria is limited. Studies conducted in first world countries have reported that the primary caregivers of persons with breast cancer benefit from psycho-educational interventions (O’Hara et al., 2010; Stenberg et al., 2010; Yoon et al., 2014). Breastcancer Caregiver

A variety of interventions have been implemented to assist caregivers in managing the effects of the caregiving burden on QOL (Dolbeault et al., 2009; Tan et al., 2015). The aim of this study was to implement and evaluate the effectiveness of a psychosocial intervention programme on caregiving burden and self-reported QOL of primary caregivers of women with breast cancer in Abuja, Nigeria. The main objective was to evaluate the effect of the psychosocial intervention on caregiver burden and caregiver QOL. The control group received routine care which was offered by the hospital, such as 24-h phone calls, if required by the caregivers. The nurse on duty also provided psychosocial support, such as counselling. The psychosocial support was ad hoc and as needed but not regular. 2.2. Intervention group The intervention group received the psychosocial intervention programme in addition to routine care, which included counselling, if required by the caregivers. The routine care did not overlap with the psychosocial educational programme being tested in the study. The intervention was adapted with permission from the following materials: Supporting a person who needs palliative care: a guide for family and friends (Hudson and Hudson, 2012) and the National Cancer Institute, United States Department of Health and Human Services (National Cancer Institute, 2012). 1.1. Conceptual framework This study was guided by Lazarus and Folkman’s transactional model of stress and coping, which has been advocated as a useful framework to guide caregiver research (Hudson et al., 2004). The model is useful, as when people are faced with a stressor such as breast cancer, they experience appraisal processes which, in turn, direct their adaptation to the stressor. If they cannot adapt, it affects their QOL. This framework provides a testable theoretical approach to assessing change in QOL. The theoretical model depicted in Fig. 1 was used to clarify and predict changes in perceived QOL that Results from the interaction of these factors. The variables identified in the model are significant predictors of outcomes in primary caregivers, and therefore provide a strong conceptual basis for an intervention designed to improve QOL. 2.3. Psychosocial intervention programme The intervention programme, held at a venue in the Oncology Unit of the hospital, was coordinated by the researcher. It comprised six face-to-face sessions (once a week for six weeks) delivered by four research assistants (registered nurses who were trained by the researcher in the ethical conduct of research, and their roles in the study process). Each session was 90 min in length; a presentation of thematic content followed by questions and discussion. Each session had a specific theme: • Introduction and essential information about breast cancer • Adjustment to the role of caregiver • Communication strategies to prevent misunderstanding and promote positive interaction between caregiver and patient • Dealing with the emotional aspect of caring • Self-care: its importance and strategies to promote self-care • Practical care information relating to the management of common 2. Breastcancer Caregiver

Methods A quasi-experimental study with pre- and post-test measures was conducted from August to November 2016, at the National Hospital, Abuja, Nigeria. Two post-test measures were obtained at six and 12 weeks from baseline. A convenience sample of primary caregivers was recruited in the outpatient clinic at the National Hospital in Abuja, Nigeria. The inclusion criteria were: adults of age 18 years or older, caring for a person with breast cancer and literate with a minimum of nine years of schooling. The care recipient (referred to as the patient in this study) was expected to have at least a six-month survival prognosis. Exclusion criteria were: professional health caregivers, as their knowledge and information could influence their participation and caregivers who, at the time of the study, were receiving treatment for breast cancer or a condition which increased their physical and/or psychological vulnerability. symptoms and dealing with the patient’s emotions. Questions from caregivers focused mainly on hereditary aspects of breast cancer, prognosis and the types and processes of treatment. Breastcancer Caregiver

At the end of each session participants were provided with an information package relating to the session theme. Fifty-one participants in the intervention group completed programme. Due to the severity of their patient’s illness, three intervention group participants did not complete the programme. Fifty-two participants in the control group completed the post intervention assessments. Caregiver burden and the caregiver QOL were assessed at baseline (before the commencement of the psychosocial intervention programme), at week six (at completion of the Fig. 1. Theoretical model of factors affecting primary caregiver QOL. In the above model, bold arrows indicate direct effects of psychosocial intervention on the appraisal factor and QOL, while lines indicate significant relationships among study variables observed from other studies. 86 European Journal of Oncology Nursing 38 (2019) 85–91 I.O. Gabriel, P.M. Mayers Fig. 2. Study design and flow. was due to critical illness of patients (n = 3, 6%) and death of patients (n = 3, 6%). All assessment forms were fully completed by all participants. intervention programme) and week 12 (follow-up). Caregivers were asked to give voluntary informed consent and informed of their right not to participate, and that should they wish to withdraw at any point, this would not affect their usual care in any way. 2.5. Instruments used to measure caregiver burden and quality of life 2.4. Procedures Caregiver burden was measured by the Zarit Burden Interview (ZBI). Breastcancer Caregiver

This is a 22-item one-factor scale reflecting areas of concern, namely health, finances, social life, emotional well-being, personal life, and interpersonal relationships (Ozer et al., 2012). The scale is divided into three domains: role strain, personal strain and competencies and expectations. Items are worded subjectively, focusing on the affective response of the caregiver (Bianchi et al., 2016). The ZBI is scored on a 5-point Likert scale. Each item is scored from 0 to 4, where 0 = never, 1 = rarely, 2 = sometimes, 3 = quite frequently, and 4 = nearly always. The total ZBI is obtained by adding the scores for the 22 items with a range of 0–88; higher scores indicate greater burden (Zarit et al., 1980). Breastcancer Caregiver

 Cronbach’s alpha for this instrument in this study was 0.73. Caregiver quality of life was measured by the Caregiver Quality of Life Index Cancer (CQOLC). This is a 35-item self-report questionnaire scored on a five-point Likert-type scale that yields a single QOL score, ranging from 0 = not at all to 4 = very much. The CQOLC instrument is divided into domains: burden, disruptiveness, positive adaptation, financial concerns and independent items (Duan et al., 2015; Son et al., 2012). Ten items relate to burden; seven to disruptiveness; seven to positive adaptation; three to financial concerns and eight to additional The researcher and research assistants approached the health staff working in the Oncology Unit where women with breast cancer were being treated; information about the study was explained to the staff in order for them to serve as mediators between the researcher and the primary caregivers. Information documents were posted in the clinic waiting areas and distributed by the oncology nurses. Staff identified potential participants. Breastcancer Caregiver

One hundred and thirty-five primary caregivers were approached over a two-week period in August 2016, of whom 108 agreed to participate in the study (response rate 80%). Reasons for declining to participate are listed in Fig. 2. After participants had signed written informed consent, the researcher allocated them to each arm of the study (intervention or control group) using sequential numbers (1–108); those with even numbers were assigned to the intervention group (n = 54), .Breastcancer Caregiver