Caregiver Responses Research Articles

Validation of Caregiver-Centered Delirium Detection Tools: A Systematic Review.

To summarize the validity of caregiver-centered delirium detection tools in hospitalized adults and assess associated patient and caregiver outcomes. Systematic review. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus from inception to May 15, 2017. Hospitalized adults. Caregiver-centered delirium detection tools. We drafted a protocol from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers independently completed abstract and full-text review, data extraction, and quality assessment. We summarized findings using descriptive statistics including mean, median, standard deviation, range, frequencies (percentages), and Cohen's kappa. Studies that reported on the validity of caregiver-centered delirium detection tools or associated patient and caregiver outcomes and were cohort or cross-sectional in design were included. We reviewed 6,056 titles and abstracts, included 6 articles, and identified 6 caregiver-centered tools. All tools were designed to be administered in several minutes or less and had 11 items or fewer. Three tools were caregiver administered (completed independently bycaregivers): Family Confusion Assessment Method (FAM-CAM), Informant Assessment of Geriatric Delirium (I-AGeD), and Sour Seven. Three tools were caregiver informed (administered by a healthcare professional using caregiver input): Single Question in Delirium (SQiD), Single Screening Question Delirium (SSQ-Delirium), and Stressful Caregiving Response to Experiences of Dying. Caregiver-administered tools had better psychometric properties (FAM-CAM sensitivity 75%, 95% confidence interval (CI)=35-95%, specificity 91%, 95% CI=74-97%; Sour Seven positive predictive value 89.5%, negative predictive value 90%) than caregiver-informed tools (SQiD: sensitivity 80%, 95% CI=28.4-99.5%; specificity 71%, 95% CI=41.9-91.6%; SSQ-Delirium sensitivity 79.6%, specificity 56.1%). Delirium detection is essential for appropriate delirium management. Caregiver-centered delirium detection tools show promise in improving delirium detection and associated patient and caregiver outcomes. Comparative studies using larger sample sizes and multiple centers are required to determine validity and reliability characteristics.

Development of Infant Pointing from 10 to 12 months: The Role of Relevant Caregiver Responsiveness

Infants’ pointing frequency is a predictor of their later language abilities. Yet, predictors of pointing frequency in the first year of life are not well understood. Study 1 explored what factors in infants and caregivers at 10 months would predict the pointing frequency of infants at 12 months (N = 35). Infant‐driven predictors were infants’ fine‐motor skills and point‐following abilities. Caregiver‐mediated predictors were caregivers’ pointing frequency and responsiveness toward infants’ pointing. Relevant caregiver responsiveness at 10 months predicted infants’ pointing frequency at 12 months, controlling for the other factors and infants’ prior pointing frequency. Study 2 explored whether child‐level factors influence caregivers’ responsiveness (N = 49). We examined the hand shape of infants’ pointing (whole‐hand versus index‐finger) and the presence of point‐accompanying vocalizations. Infants’ vocalization‐accompanied points were more likely to elicit relevant responses from caregivers, while hand shapes played a less pronounced role. Together, the findings reveal an early emerging mutual relationship between infant pointing and caregiver behavior such that certain characteristics of infant pointing predict caregivers’ responsiveness, and relevant responsiveness toward infants’ pointing predicts the increase in infants’ pointing frequencies.

Caregiver experiences of public services following child trauma exposure: a qualitative study

BackgroundMany children in low and middle income countries (LMIC) are exposed to trauma. Contact with public services are a potential influence on parent–child reactions and coping post-trauma. Little is known about how caregivers perceive these interactions.MethodsThe aim of this study was to explore caregivers’ experiences of accessing and interacting with public services post-trauma and perceptions of needed improvements to public services in a LMIC context. Qualitative interviews were conducted with 20 female caregivers from a high-risk settlement in South Africa after child trauma exposure.ResultsThree themes and seven sub-themes were identified regarding caregivers’ perceptions of interactions with public services post-trauma. The key themes identified related to (1) communication and exchanges with law enforcement, (2) consequences of an under-resourced justice system and (3) importance of communication and empathy in the healthcare system. Interactions with police were often positive. However, caregivers explained that police-family communication post-trauma could be improved and may help to lessen caregiver anxiety and concerns for the child’s safety post-trauma. Caregivers perceived the judicial system to be under-resourced as contact with the judicial system was often protracted and caused child anxiety and distress. Medical treatment was reportedly rushed, with extensive waiting times and little information provided to caregivers regarding the child’s injuries or treatment. Some medical staff were perceived as unsympathetic during the child’s treatment which was found to exacerbate caregiver and child distress post-trauma.ConclusionsThis study provides insight into caregiver experiences of accessing public services following child trauma exposure in a high-risk LMIC context. Public services were perceived as oversubscribed and under-resourced and negative interactions often influenced caregiver responses and appraisals of child safety. Given the impact of poor interactions with public services on families post-trauma, additional research is needed to investigate feasible improvements to public services in LMIC.

Lack of Accurate Self-appraisal is Equally Likely in MCI from Parkinson's Disease and Alzheimer's Disease.

How accurate are mild cognitive impairment (MCI) patients in assessing their cognitive and functional deficit is often unclear to the clinician. The accuracy of patient self-appraisal in Parkinson's disease-MCI (PD-MCI) has received less attention than amnestic MCI (a-MCI) often associated with Alzheimer's disease. We evaluated if PD-MCI patients demonstrate accurate self-appraisal of their cognitive deficits compared to patients with amnestic a-MCI or non-amnestic MCI (na-MCI). This cross-sectional cohort study included, 30 PD-MCI, 33 a-MCI, and 17 na-MCI patients. Self-appraisal was assessed by comparing responses of caregivers and patients on a validated self-rating questionnaire of cognitive and functional impairments. All patients completed a full neuropsychological evaluation and depression screening measure. Univariate ANOVA, regression, and correlational analyses were employed to identify group differences in self-appraisal scores and relationships between cognitive and functional impairment, depression measures, and self-appraisal scores. Self-appraisal scores for PD-MCI did not differ significantly from a-MCI and na-MCI. In the PD-MCI group, higher depression scores were associated with lower self-appraisal scores (i.e, patients assessed cognition as worse than caregivers). In a stepwise regression model with self-appraisal scores as the dependent variable, only the depression score was significant predictor among PD-MCI and accounted for 50% of the variance. Our findings suggest that impaired patient self-appraisal is equally likely to occur in PD-MCI as in a-MCI and na-MCI patients. Among PD-MCI, depression was the strongest predictor of impaired patient self-appraisal. Impaired insight into cognitive impairment and depression should be considered in both care and research with PD patients.

Adaptation, Resilience, and Secure Attachment States of Mind in Young South African Female Students Exposed to Intimate Partner Violence in Childhood.

Much research details the psychological risks to individuals exposed as children to intimate partner violence (IPV). However, resilience has been a neglected area of study within this population. This article details adaptive responses in six participants exposed to IPV in childhood. Adult attachment interviews (AAI) and follow-up semi-structured interviews analyzed using an interpretive thematic analysis revealed common themes relating to psychological defenses and adaptive strategies. Despite exposure to IPV in childhood, these six women were found to have secure attachment states of mind. Resilience was found not to be necessarily synonymous with the absence of distress. Despite the presence of suffering, it remained strongly associated with adaptive, robust defenses to manage distress and to retain caregiving relationships with parents. These defenses appeared to provide participants with ways to survive their traumatic environments and to remain connected to needed but frightening caregiving figures, and facilitated processing of trauma. Adaptation often entailed using compliance and caregiving responses in childhood in response to role reversal in parent-child relationships, but also the relinquishing of these roles in adulthood. Participants' abilities to coherently acknowledge and discuss their early experiences and retain compassion for their parents seemed linked to their abilities to attain some distance from troubling aspects of their pasts. In doing so, they separated from the unstable relationships of their parents, which fostered transitions to more integrated states of mind.

Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy.

BackgroundAlthough current guidelines emphasize the importance of social support to the success of left ventricular assist device (LVAD) therapy, few studies examine the influence of the caregiver on patient outcomes or quantify the impact of LVAD caregiving on caregiver outcomes. The purpose of this analysis was to identify patient and caregiver determinants of patient quality of life (QOL) and caregiver strain in response to LVAD therapy.Methods and ResultsData on patients receiving LVAD therapy and their caregivers (n=50 dyads) were prospectively collected pre‐implantation and 1, 3, and 6 months post‐implantation. Growth curve modeling was used to describe change in patient QOL (Kansas City Cardiomyopathy Questionnaire) and caregiver strain (Multidimensional Caregiver Strain Index). Patient QOL improved most in the first month (β=23.22±3.76, P<0.001), followed by gradual gains over 6 months (β=1.90±0.64, P<0.01). Caregivers experienced worsening of strain in the first month (β=4.30±1.42, P<0.01), followed by gradual resolution to pre‐implantation levels by 6 months (β=−0.71±0.23, P<0.01). Worse pre‐implantation patient symptoms were associated with greater improvement in patient QOL (β=0.53±0.19, P<0.01) but worsening caregiver strain (β=0.15±0.07, P=0.04). Better relationship quality was associated with greater improvement in patient QOL (β=14.39±5.85, P=0.01) and less pre‐implantation caregiver strain (β=−9.31±2.28, P<0.001). Nonspousal caregivers experienced less pre‐implantation strain (β=−8.60±3.10, P=0.01), and patients with nonspousal caregivers had less improvement in QOL (β=−3.70±1.62, P=0.02).ConclusionsA combination of patient and caregiver characteristics predicts patient and caregiver response to LVAD therapy. Including caregiver factors in future studies may be helpful in developing interventions that improve patient and caregiver outcomes, together.

Detach Yourself: The Positive Effect of Psychological Detachment on Patient Safety in Long-Term Care.

Delivering health care is emotionally demanding. Emotional competencies that enable caregivers to identify and handle emotions may be important to deliver safe care, as it improves resilience and enables caregivers to make better decisions. A relevant emotional competence could be psychological detachment, which refers to the ability to psychologically detach from work and patients in off-duty hours. The objective of this study was to examine the relationship between psychological detachment and patient safety. In addition, the ability of teams to create a safe environment to discuss errors and take personal risks, i.e., psychological safety, was explored as an underlying condition for psychological detachment. A total of 1219 caregivers (response rate = 44%) from 229 teams in two long-term care organizations completed a survey on psychological safety and psychological detachment at T0. Team managers rated patient safety of those teams at two points in time (T0 and T1). Two-level regression analysis showed that both psychological safety (β = 0.72, P < 0.01) and psychological detachment (β = 0.54, P < 0.05) relate directly to patient safety. Psychological safety relates positively to psychological detachment (β = 0.48, P < 0.01) but was, however, not an underlying condition. Perceived patient safety is enhanced by emotional competencies, at individual level by psychological detachment and at team level by psychological safety. Caregivers should be aware of the important influence emotional competencies have on patient safety and be trained to develop these competencies. Future research should focus on exploring underlying conditions for emotional competencies.

Abstract WMP111: Assessing Caregiver Commitment and Capacity

Care transitions for individuals with disabling conditions, such as stroke, are often ineffective and inefficient, resulting in unmet patient and caregiver (CG) needs, increased safety risks, high rates of preventable readmissions, and increased health care costs. This is particularly problematic for stroke patients transitioning from an inpatient rehabilitation facility (IRF) to home. There is no assessment instrument specifically designed to evaluate a family member’s commitment and capacity to assume the caregiving role following a stroke survivor (SS) discharge from an IRF or sub-acute facility. This is critically needed to facilitate the development of tailored care plans and interventions to mitigate risks associated with the crisis of stroke and the associated health effects on the CG and SS. The purpose of this study is determine the psychometric properties of the Preparedness Assessment for the Transition Home after Stroke (PATH-s) instrument. The PATH-s instrument is a 25-item, 4-point scale based on the foundational work of B. Lutz (Co-Investigator). A prospective cohort study was conducted to establish the psychometric properties of the PATH-s instrument using a convenience sample of 184 SSs and their family caregivers during IRF admission. Data collection from SSs and CGs at IRF admission was conducted to determine the quality of the items, internal consistency, reliability, construct validity, and criterion-related validity. We will describe the characteristics of CG responses on the PATH-s instrument during IRF in addition to correlation with other measures (general health, perceived stress, depression). This novel instrument can support a primary prevention strategy to identify gaps in preparedness for stroke survivor-caregiver dyads following the complex transition from IRF to home, with the long-range goal to mitigate the effects of suboptimal preparation and the associated adverse effects associated with this transition on the health of CGs and SSs. Once gaps are identified, care plans can be tailored to address gaps and better prepare caregivers for the transition home.

Refining the assessment of disrupted maternal communication: Using item response models to identify central indicators of disrupted behavior.

The Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; Bronfman, Madigan, &amp; Lyons-Ruth, 2009-2014; Bronfman, Parsons, &amp; Lyons-Ruth, 1992-2004) is a widely used and well-validated measure for assessing disrupted forms of caregiver responsiveness within parent-child interactions. However, it requires evaluating approximately 150 behavioral items from videotape and extensive training to code, thus making its use impractical in most clinical contexts. Accordingly, the primary aim of the current study was to identify a reduced set of behavioral indicators most central to the AMBIANCE coding system using latent-trait item response theory (IRT) models. Observed mother-infant interaction data previously coded with the AMBIANCE was pooled from laboratories in both North America and Europe (N = 343). Using 2-parameter logistic IRT models, a reduced set of 45 AMBIANCE items was identified. Preliminary convergent and discriminant validity was evaluated in relation to classifications of maternal disrupted communication assigned using the full set of AMBIANCE indicators, to infant attachment disorganization, and to maternal sensitivity. The results supported the construct validity of the refined item set, opening the way for development of a brief screening measure for disrupted maternal communication. IRT models in clinical scale refinement and their potential for bridging clinical and research objectives in developmental psychopathology are discussed.

The Influences of Child Intelligibility and Rate on Caregiver Responses to Toddlers With and Without Cleft Palate.

The purpose of this study was to investigate the influences of child speech intelligibility and rate on caregivers' linguistic responses. This study compared the language use of children with cleft palate with or without cleft lip (CP±L) and their caregivers' responses. Descriptive analyses of children's language and caregivers' responses and a multilevel analysis of caregiver responsivity were conducted to determine whether there were differences in children's productive language and caregivers' responses to different types of child utterances. Play-based caregiver-child interactions were video recorded in a clinic setting. Thirty-eight children (19 toddlers with nonsyndromic repaired CP±L and 19 toddlers with typical language development) between 17 and 37 months old and their primary caregivers participated. Child and caregiver measures were obtained from transcribed and coded video recordings and included the rate, total number of words, and number of different words spoken by children and their caregivers, intelligibility of child utterances, and form of caregiver responses. Findings from this study suggest caregivers are highly responsive to toddlers' communication attempts, regardless of the intelligibility of those utterances. However, opportunities to respond were fewer for children with CP±L. Significant differences were observed in children's intelligibility and productive language and in caregivers' use of questions in response to unintelligible utterances of children with and without CP±L. This study provides information about differences in children with CP±L's language use and caregivers' responses to spoken language of toddlers with and without CP±L.

Infant iron deficiency, child affect, and maternal unresponsiveness: Testing the long-term effects of functional isolation.

Children who are iron deficient (ID) or iron-deficient anemic (IDA) have been shown to seek and receive less stimulation from their caregivers, contributing to functional isolation. Over time, the reduced interactions between child and caregiver are thought to interfere with the acquisition of normative social competencies and adversely affect the child's development. The current study examined functional isolation in children who were ID or IDA in infancy in relation to social difficulties in middle childhood and problem behaviors in adolescence. Using a sample of 873 Chilean children, 45% of whom were ID or IDA in infancy, structural equation modeling results indicated that infant IDA was associated with children's dull affect and social reticence at age 5, which were related to mothers' unresponsiveness and understimulation. Mothers' limited responsiveness and stimulation were, in turn, related to children's peer rejection at age 10, which further linked to problem behaviors and associating with deviant peers at adolescence. Findings support the functional isolation hypothesis and suggest that early limited caregiver responsiveness and stimulation contribute to long-term social difficulties in adolescents who were iron-deficient anemic in infancy. (PsycINFO Database Record

Constructing the 32-item Fitness-to-Drive Screening Measure.

The Fitness-to-Drive Screening Measure© (FTDS) enables proxies to identify at-risk older drivers via 54 driving-related items, but may be too lengthy for widespread uptake. We reduced the number of items in the FTDS and validated the shorter measure, using 200 caregiver responses. Exploratory factor analysis and classical test theory techniques were used to determine the most interpretable factor model and the minimum number of items to be used for predicting fitness to drive. The extent to which the shorter FTDS predicted the results of the 54-item FTDS was evaluated through correlational analysis. A three-factor model best represented the empirical data. Classical test theory techniques lead to the development of the 32-item FTDS. The 32-item FTDS was highly correlated ( r = .99, p = .05) with the FTDS. The 32-item FTDS may provide raters with a faster and more efficient way to identify at-risk older drivers.

Caregiver Responses to Child Posttraumatic Distress: A Qualitative Study in a High-Risk Context in South Africa.

Many low‐ and middle‐income countries (LMIC) have high rates of child trauma exposure and limited access to psychological services. Caregivers are often a child's key source of support following trauma in such contexts. The aim of this study was to explore the experiences of primary caregivers in supporting their child posttrauma. Qualitative interviews were conducted with 20 female caregivers from a high‐risk settlement in Cape Town following child trauma exposure. Children were exposed to significant traumatic events, including gang violence, assault, and fatalities of close relatives. The data were analyzed using thematic analysis; several key themes emerged. First, caregivers were typically aware of child distress posttrauma, based primarily on manifest behaviors. Second, caregivers identified varied ways of providing support, including being warm and responsive; seeking to ensure physical safety by encouraging the child's perceptions of the community as dangerous; and encouraging forgetting as a way of coping, with limited discussions of the event. Third, many barriers existed to accessing psychological treatment, and caregivers had low involvement in any interventions. Finally, caregivers also experienced significant distress that could impact their responses to their child. The results illustrate the challenges faced by caregivers in supporting children following trauma in LMIC contexts and the need for accessible psychological interventions.

Transformative Holding: A Reflection on the Legacy of the Smith School for Social Work Thesis

ABSTRACTThe Smith College School for Social Work thesis offers the student the opportunity to be nurtured into a competent clinician within the holding environment of the advisor–advisee relationship. My master’s thesis focused on caregiver response to infant sleep-related crying. This reflection describes the progression in my thesis process from focusing on how letting an infant “cry it out” neglects the infant’s psychological development to a more nuanced understanding of the caregiver’s subjectivity as central in the infant’s development of regulatory functions. My shift in understanding of the self and self-other relating was only possible through the deeply personal experience of being held within the advisor–advisee relationship. The containing function in this relationship parallels the way in which a “good enough” caregiver nurtures an infant. I conclude with a clinical vignette that exemplifies the expression of my internal transformation.

Toward the identification of adaptive functioning intervention targets for intellectually-able, transition-aged youth with autism: An examination of caregiver responses on the Vineland-II.

Adolescents and young adults with autism spectrum disorder (ASD) without intellectual disability demonstrated impaired adaptive functioning skills (i.e., age appropriate skills necessary for independent living). Development of adaptive functioning skills appears to slow with age among individuals without intellectual disability. Findings clarify the specific adaptive functioning skills that transition-aged youth with ASD have difficulty completing independently and will inform the development of interventions to increase the likelihood of independent living in adulthood.

Exploring Factors Relating to Positive Outcomes for Youth with Bipolar Spectrum Disorder: A Multi-Informant, Mixed Methods Study

Bipolar Spectrum Disorder (BSD) is a severe psychiatric disorder, and relatively little is known about positive outcomes for youth with this diagnosis. Employing a multi-informant, mixed-methods approach, this study sought to a) gain a deeper understanding of positive factors identified by youth with a diagnosis of BSD and their caregivers; and b) understand how the parenting context relates to positive functioning among youth with a diagnosis of BSD. A clinical sample of 18 families with a youth diagnosed with BSD participated, completing measures of parenting style, resiliency, positive schemas, mania, depression, and a telephone interview with a qualitative component. Qualitative analyses revealed most caregivers described their youth with BSD as having strong interpersonal relationship qualities and positive internal characteristics. Youth responses cohered largely with caregiver responses. Parental acceptance related to all measures of positive functioning, and results further suggested positive schemas may be one mechanism linking parental acceptance to resiliency for youth with BSD. Despite the severity of a BSD diagnosis, caregivers and youth reported on many positive aspects of their experiences. These results also inform a more complex view of the relation between parenting and resiliency for youth with BSD. With replication, the findings from this preliminary sample may inform the design of future measures of positive functioning for youth with BSD and inform the development of treatment and intervention programs for families coping with BSD.

The Play Environments of Home and Childcare Institutions and Children’s Play Behavior

본 연구는 가정과 육아지원기관의 놀이환경이 유아의 놀이행동(놀이상호작용, 놀이방해, 놀이단절)에 미치는 영향을 살펴보고자 한국아동패널 7차년도 조사에 참여한 1,203명의 자료를 분석하였다. 연구의 주요 결과는 다음과 같다. 우선 가정 및 육아지원기관의 놀이환경 모두 유아의 놀이행동에 영향을 미치는 것으로 나타났다. 구체적으로 유아의 놀이상호작용에는 교사-유아상호작용, 성별, 가정에서의 실외놀이시간, 가구소득이, 놀이방해에는 성별, 교사-유아상호작용, 가정에서의 실내놀이시간, 가정 내 물리적 환경, 사교육 이용횟수가, 놀이단절에는 교사-유아상호작용, 교실규모의 적절성, 양육자의 반응성이 영향을 미치는 것으로 나타났다. 본 연구는 가정과 육아지원기관에서 유아의 놀이권 보장을 위한 환경을 조성하는 것, 즉 유아에게 놀이시간과 놀이공간을 충분히 제공하고, 자유로운 놀이활동을 보장하며, 부모 및 교사가 유아와 원활한 상호작용을 유지하는 것이 유아의 놀이행동에 긍정적 영향을 미친다는 것을 밝혔다는데 의의가 있다.The objective of this study is to analyze the 1,203 children in the 7th Panel Study on Korean Children (PSKC). We explore the influence of play environments of home and childcare institutions on play behavior (i.e., play interactions, play disruption, play disconnection). The results of the study show that the play environment of the childcare institutions influenced the play behavior of children more than the play environment of the home. In particular, the influence of teacher on the play behavior of children was the greatest. Second, play interaction was also influenced by teacher to child interaction, gender, outdoor play time at home, and household income. Third, the play disruption of children was influenced by gender, teacher to child interaction, physical environment at home, and the number of private tutoring. Fourth, the play disconnection of children was influenced by teacher to child interaction, the responsiveness of caregivers, and the appropriateness of classroom size. The study suggests that healthy play behaviors appear when the children’s play rights are guaranteed and play environments suitable for development are provided. We expect that this study can be used as a basic data for constructing a healthy play environment for the guarantee of children’s play rights.

The effect of young children's faeces disposal practices on child growth: evidence from 34 countries.

To characterize the relationship between child faeces disposal and child growth in low- and middle-income countries. We analysed caregiver responses and anthropometric data from Demographic and Health Surveys (2005-2014) for 202614 children under five and 82949 children under two to examine the association between child faeces disposal and child growth. Child faeces disposal in an improved toilet was associated with reduced stunting for children under five [adjusted prevalence ratio (aPR)=0.90, 95% confidence interval (CI) 0.89-0.92] and a 0.12 increase in height-for-age z-score (HAZ; 95% CI: 0.10-0.15) among all households. Among households with improved sanitation access, practicing improved child faeces disposal was still associated with a decrease in stunting (aPR=0.94, 95% CI: 0.91-0.96) and a 0.09 increase in HAZ (95% CI: 0.06-0.13). Improved child faeces disposal was also associated with reductions in underweight and wasting, and an increase in weight-for-age z-score (WAZ), but not an increase in weight-for-height z-score (WHZ). Community coverage level of improved child faeces disposal was also associated with stunting, with 75-100% coverage associated with the greatest reduction in stunting. Child faeces disposal in an unimproved toilet was associated with reductions in underweight and wasting, but not stunting. Improved child faeces disposal practices could achieve greater reductions in child undernutrition than improving toilet access alone. Additionally, the common classification of child faeces disposal as 'safe' regardless of the type of toilet used for disposal may underestimate the benefits of disposal in an improved toilet and overestimate the benefits of disposal in an unimproved toilet.

Patients' and family caregivers' understanding of the cancer stage, treatment goal, and chance of cure: A study with patient-caregiver-physician triad.

Accurate understanding of the extent of disease, treatment goal, and prognosis is a prerequisite for patients with cancer and their caregivers to make informed decision. We sought to evaluate patients' and family caregivers' understanding of the cancer stage, treatment goal, and chance of cure taking their own physician's evaluation as reference. A national survey was performed with 750 patient-caregiver dyads (75.5% participation rate) recruited by 134 oncologists in 13 cancer centers (93% participation rate) in South Korea. Both patients and caregivers were asked to report their knowledge of patient's cancer stage, treatment goal, and chance of cure. Concordance was evaluated with percentage agreement and weighted κ, and predictors of discordance of patient and caregiver's response with that of physician's were explored by multivariate regression analyses with mixed effect model. The agreement rates between patient-physician and caregiver-physician were 63.0% and 65.9% for disease stage, 69.0% and 70.0% for treatment goal, and 41.4% and 45.1% for chance of cure. When discordance occurs, patients and caregivers often had an optimistic view. Distant stage, older age, female sex, and absence of depression were associated with optimistic view of patients, and there was significant between-physician variance for all 3 outcomes. The discordance revealed that our study suggests the need for better communication between physician and patients, as well as the caregivers. Research is needed to develop a comprehensive strategy to improve the understanding of the patients and family so that treatment decisions are made based on realistic estimation.

Postpartum depressive symptoms moderate the link between mothers' neural response to positive faces in reward and social regions and observed caregiving.

Postpartum depression may disrupt socio-affective neural circuitry and compromise provision of positive parenting. Although work has evaluated how parental response to negative stimuli is related to caregiving, research is needed to examine how depressive symptoms during the postpartum period may be related to neural response to positive stimuli, especially positive faces, given depression’s association with biased processing of positive faces. The current study examined the association between neural response to adult happy faces and observations of maternal caregiving and the moderating role of postpartum depression, in a sample of 18- to 22-year old mothers (n = 70) assessed at 17 weeks (s.d. = 4.7 weeks) postpartum. Positive caregiving was associated with greater precuneus and occipital response to positive faces among mothers with lower depressive symptoms, but not for those with higher symptoms. For mothers with higher depressive symptoms, greater ventral and dorsal striatal response to positive faces was associated with more positive caregiving, whereas the opposite pattern emerged for mothers with lower symptoms. There was no association between negative caregiving and neural response to positive faces or negative faces. Processing of positive stimuli may be an important prognostic target in mothers with depressive symptoms, given its link with healthy caregiving behaviors.