Caregivers In Taiwan Research Articles

Factors Associated with Attitude and Knowledge Toward Hospice Palliative Care Among Medical Caregivers

The present study aimed to explore the attitude and knowledge toward hospice palliative care among medical caregivers in Taiwan. A cross-sectional questionnaire survey was conducted among medical staff attending a hospice palliative care conference. Overall, 163 of 232 questionnaires were valid. Based on the results, 54.9% of opinions on who has the right to sign a Hospice Palliative Care Declaration for an autonomous patient was consistent with the Taiwan Hospice Palliative Care Article; 91.4% of opinions on whether a life-sustaining therapy has been authorized to withhold was consistent with the article, compared with only 28.3% of opinions on whether a life-sustaining therapy has been authorized to withdraw. The capability of medical staff to provide these three procedures was varied (Cochran's Q = 121.150, p < 0.001). The medical staff who were aged > 32.5 years (odds ratio = 0.41; 95% confidence interval, 0.22–0.90; p < 0.01), and whose work experience was >9 years (odds ratio = 0.52; 95% confidence interval, 0.27–0.97; p < 0.05) tended to approach patients' informed consent of Hospice Palliative Care Declaration precisely. Life and work experience improve the accuracy of medical staff in providing hospice palliative care. A culture-based, case-oriented continuing education program and a timely revision of the Hospice Palliative Care Article are recommended to increase the consistency between the principle and the practice of hospice palliative care.

Development and Psychometric Testing of the Suicide Caring Competence Scale (SCCS) for Family Caregivers in Taiwan

Suicide caring competence is important for family caregivers to care their relatives with suicidal tendencies. The purpose of this study was to develop and test the psychometric properties of the Suicide Caring Competence Scale (SCCS) for family caregivers in Taiwan. A 20-item SCCS was tested on 165 family caregivers. Confirmatory factor analysis indicated that five subscales with 19 items best fit the data. The Cronbach's α and test–retest reliability of the SCCS was 0.90 and 0.81, respectively. The SCCS demonstrated acceptable construct validity and reliability. Nurses can use the SCCS to assess the suicide caring competence of family caregivers.

Planting Hope in Loss and Grief: Self-Care Applications of Horticultural Therapy for Grief Caregivers in Taiwan

In 2008, the Taiwan Association for Care and Counseling for Loss organized a workshop about Horticultural Therapy, conducted as a participatory action research (PAR). Nineteen grief caregivers participated. Specific goals were designed according to a survey of participant expectations and focus-group discussions. The workshop content included lectures and interactive activities. Results demonstrated that most participants displayed an increased awareness of personal loss and meaning in grief, indicating that horticulture and nature appreciation might relieve individual grief and stress. The report introduces the rationale, evolution, execution, and results of the program development.

Caregivers' Self-Efficacy and Burden of Managing Behavioral Problems in Taiwanese Aged 65 and Over with Dementia

In this study we explored caregivers' self-efficacy for managing people aged 65 and over with dementia behavior disturbance (DBD) and examined factors associated with the perception of care burden. A purposive sample of 162 community-dwelling people aged 65 and over with dementia and 162 primary family caregivers in Taiwan participated. The results revealed that frequency of DBD, caregivers' female gender, caregivers' level of education, relationship with care recipient, hours of care, and caregiver's self-efficacy in managing DBD were significantly correlated to the care burden, and explained up to 36.1% of the variance. Moreover, self-efficacy of DBD management in relation to inappropriate sexual behaviors, aggressive behaviors, general aimlessness, and lack of cooperation significantly contributed to the caregivers' perception of care burden. Healthcare professionals could use these results to design appropriate interventions to alleviate the care burden.

Prevalence and factors related to depressive symptoms among family caregivers of nursing home residents in Taiwan

The purpose of this cross-sectional study was to understand the prevalence and risk factors for depressive symptoms among nursing home residents' family caregivers in Taiwan. Family caregivers (n=191) of nursing home residents were recruited by stratified random sampling from 16 nursing homes throughout Taiwan. Data were collected from caregivers in face-to-face interviews on depressive status (using the Center for Epidemiologic Studies Depression Scale; CES-D), on meaning ascribed to visiting nursing home residents (using the Family Meaning of Nursing-Home Visits scale), and on demographic data. Factors related to depressive symptoms were analyzed by multiple logistic regression. The prevalence of depressive status among family caregivers was 29.8% as determined by the CES-D cutoff score of ≥10. The non-depressed group (CES-D <10) tended to visit residents for emotional maintenance (odds=0.54), while the depressed group (CES-D ≥10) tended to visit due to sense of responsibility for monitoring care quality (odds=3.25). These results demonstrate that risk factors for depressive symptoms in family caregivers were their age, self-perceived health status, education level, and being the resident's main caregiver before admission. These results fill a gap in knowledge by providing detailed, evidence-based data on family caregivers' priorities for visiting nursing home residents and it is related to depression. These results also provide useful information for designing intervention protocols to reduce depressive symptoms in family caregivers of nursing home residents, not only in Asian countries, but also in western countries with many Chinese/Asian immigrants.

Work and leisure among Indonesian professional family caregivers in Taiwan: reality versus dreams

Although informal caregivers are the main caregiving workforce, there is an increasing reliance on immigrant professional caregivers in developed and developing countries. Few studies have examined the impact of caregiving on leisure for professional caregivers. Most professional family caregivers in Taiwan, working alone at the employers' home, are from Indonesia. The present study explored the work and leisure of Indonesian paid live-in family caregivers. A time budget approach was employed to collect data during May 2010. Forty female caregivers participated, resulting in 13,873 diary events divided into three categories: committed activities; obligatory activities; and discretionary time activities. The results revealed that the respondents: (1) worked extremely long hours, lacked leisure and felt lonely and tired; but (2) were nevertheless able to experience leisure during their work, obligatory and discretionary time. The line between work and leisure was blurred, and respondents' lives in Taiwan revealed a complex picture of leisure and caregiving. For the female professional caregivers in the present study, leisure must be understood within the context of caregiving and family obligations. Research implications are discussed, recommendations to policymakers and employers are offered and directions for future research are canvassed.

P2‐348: Caregivers' perspectives of care problems: An exploratory study in Taiwan

Background:Caregiver burden is known as a multidimensional phenomenon and strongly influenced by sociocultural contexts. Literature reported cultural differences in the appraisals of dementia that affect caregivers’ perceived burden. This study explores the caregiver’s perspectives of the care problems in daily routine.Methods:This study adopted a qualitative approach. 30 consecutive consultation sessions from a Dementia Consultation Clinic in Taiwan were videotaped and the content transcribed. The transcripts were coded to identify the most frequent care problems identified by the caregivers. Five follow-up in-depth interviews were conducted with the caregivers who reported most care problems. The participants included one husband, one wife, two sons, and one daughter. They all lived and provided care for their relatives with dementia at home. The transcripts were analyzed with Grounded theory. Results: Four themes associated with the care problems reported by the caregivers: (1) Most of the caregiving difficulties were associated with behavioral problems associatedwith dementia. (2) These behavioral problems usually became a source of caregiver distress when they significantly affected the safety of care recipients or caregivers, and/or disrupted the daily lives of the whole family. (3) The behaviors were mostly attributed to the personality or lifelong habits of care recipient rather than the symptoms of dementia. Thus, the behaviors were often not considered modifiable. (4) The caregivers considered the management of disruptive problems as their moral responsibilitis and were reluctant to seek help. Conclusions: The results agreed with the literature that the behavioral problems of dementia were a frequent caregiving stressor. It also supports that Asian caregivers may consider caring for the elderly in the family as their destiny and responsibility that cannot be shared with others. Not discussed in previous literature was that how Taiwanese caregivers’ attribution of behavioral problems influenced their coping strategies. As the caregivers in Taiwan tend to regard the behavioral problems un-modifiable or associate the ability to manage behavioral problems with one’s morale, these considerations influences the caregiver’s decision to seek help. More caregiver educations may help them be well aware of dementia symptoms and develop more useful coping strategies.

The Effects of a Support Group on Dementia Caregivers’ Burden and Depression

The aim of the study is to investigate the effects of a support group on depression levels and burden among dementia caregivers in Taiwan. An experimental, pre-intervention postintervention control group design was used in this study. The experimental group received intervention consisting of a 12-week support group for dementia caregivers. A total of 85 subjects were evaluated before intervention, after intervention, and at 1-month follow-up. (a) The depression level of participants in the experimental group was significantly decreased after the intervention and at 1-month follow-up. (b) There was no significant difference in caregiver's burden after the support group intervention and 1-month follow-up. The improvement in dementia caregivers' depression levels shows that the support group was effective for reducing caregivers' depression although not effective for relieving their burden of care.

Decision-Making Process of Nursing Home Placement Among Chinese Family Caregivers

To understand the process and difficulties that Chinese family caregivers experience when making a nursing home placement decision for their loved ones with dementia. Using a grounded theory approach, data were collected through individual interviews with 30 Chinese family caregivers in Taiwan. A stage-based framework was generated that described how caregivers went through the decision-making process, what specific challenges they encountered within the process, and how they overcame difficulties to reach their decisions. By identifying the stages of the decision-making process and various challenges that caregivers experience, clinicians can enhance discussions with caregivers to decrease the decision-making burden. Clinicians might develop family-centered interventions for the decision-making process through the post-placement stage while taking into account cultural influences.

Stressors, social support, depressive symptoms and general health status of Taiwanese caregivers of persons with stroke or Alzheimer’s disease

This study examined the relationships among stressors, social support, depressive symptoms and the general health status of Taiwanese caregivers of individuals with stroke or Alzheimer's disease. Caring for a disabled or cognitively impaired person can be extremely stressful and often has adverse effects on caregivers' health. While research on caregiving in Taiwan has examined caregivers' characteristics, caregivers' need and caregivers' burden in caring for older people in general, little is known about Taiwanese caregivers of individuals with stroke or Alzheimer's disease. Cross-sectional, descriptive correlation design. Data were obtained from a convenience sample of 103 Taiwanese informal caregivers in the South of Taiwan and analysed using descriptive statistics, Pearson's correlations, multiple and hierarchical regressions and t-tests. Caregivers who had lower household incomes and were taking care of individuals with more behaviour problems had more depressive symptoms. In addition, caregivers who were older and were taking care of individuals with more behaviour problems had worse general health. Caregivers who had more emotional support had less depressive symptoms. Caregivers of persons with Alzheimer's disease had more depressive symptoms and worse general health than caregivers of persons with stroke. Only emotional support moderated the relationship between one of the stressors (household income) and depressive symptoms. The findings of this study may be helpful for nurses and other health care professionals in designing effective interventions to minimise the negative impacts of stressors on the psychological and general health of caregivers in Taiwan.

A family caregiver‐oriented discharge planning program for older stroke patients and their family caregivers

To test the effectiveness of a discharge planning program for dyads of older stroke survivors and their family caregivers in Taiwan. Family caregivers of stroke survivors often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. However, little information could be found on discharge planning programs for caregivers of stroke survivors in Asian families. A randomised experimental design was used to explore the effects of a discharge planning program for 158 dyads of older stroke patients and their family caregivers. The control group (n = 86 dyads) received only routine hospital discharge planning services and the experimental group (n = 72 dyads) received routine hospital discharge planning services plus the caregiver-oriented discharge planning program. Outcome variables were measured at baseline, before discharge and one month after hospital discharge. Variables were measured by the Nurse Evaluation of Caregiver Preparation Scale, Preparedness for Caregiving Scale, Caregiver Discharge Needs Satisfaction Scale and Perception of Balance between Competing Needs Scale. Caregivers in the experimental group had significantly better nurse evaluation and self-evaluation of preparation after the program than before, and greater satisfaction of discharge needs one month after discharge than before discharge. Caregivers in the experimental group had significantly better nurse evaluations and self-evaluations of preparation and better satisfaction of discharge needs after the program compared with the control group. However, no significant difference was found between caregiver groups in perceived balance of competing needs. This discharge planning program benefited family caregivers of older stroke patients during the transition from hospitalisation to one month after discharge. This caregiver-oriented discharge planning program, with its emphasis on individualised health education and home visits following discharge may improve caregivers' preparation and the satisfaction of their needs during the discharge transition.

Migrant Women’s Bodies as Boundary Markers: Reproductive Crisis and Sexual Control in the Ethnic Frontiers of Taiwan

Migrant Women’s Bodies as Boundary Markers: Reproductive Crisis and Sexual Control in the Ethnic Frontiers of Taiwan

Predictors of the Extent of Agreement for Quality of Life Assessments Between Terminally Ill Cancer Patients and their Primary Family Caregivers in Taiwan

The use of family caregivers to report patients' dying experiences has been suggested as a way of resolving the problem of non-response bias and missing data in end-of-life research. There is a dearth of information in the literature about the predictors of the extent of agreement for quality of life (QOL) assessments between patients and family informants outside of Western countries. In addition, to date there has been little progress made in deciphering meaningful influencing factors on the levels of agreement between patient and family QOL assessments. The purpose of this study was to identify the impact of the demographics and disease characteristics of patients and families, relationships of the patient to family caregiver, and caregiving burden on the extent of agreement for QOL assessments between Taiwanese terminally ill cancer patients and their family caregivers. Results from assessments by 114 dyads of Taiwanese terminally ill cancer patients and their family caregivers indicated that the extent of agreement between patient and family assessments of patient QOL was negatively influenced by the caregiving burden (amount of care needed and the impact of caregiving on caregiver's health), positively influenced by the patient's poorer health status, and there were a mixed effect of the demographics and the relationship between the patient and the family. Providing clinical care tailored at empowering families and aimed at reducing their unmet caregiving needs may improve family caregivers' abilities to assess patient QOL sensitively.

Predictors of the Extent of Agreements between Terminally ill Cancer Patients and their Family Caregivers in Taiwan

Difficulties with recruiting patients and severe attrition are common problems in studies of pal liative care and terminally ill patients. Proxies (e.g. family caregivers) have been suggested as an alternative source of information about the patients' health related quality of life (HRQOL). Such proxy assessments should be in agreement with the patients' own views. Varying degrees of agreement have been found across HRQOL do mains with the best agreement observed for more overt symptoms like dyspnoea while poorer agreement has been observed for more subjective symptoms like pain [1]. Investigation of factors affecting the level of agreement may identify subgroups of patients for whom proxy assessments are appropriate (i.e. with good agreement between patients and proxies) or inappropriate (poor agreement) and it may help improving the agreement between patients and proxies by identifying possible reasons for dis agreement. The study by Dr Tang [2] aims at identifying such factors affecting the agreement between Taiwanese terminally ill patients and their family caregivers. As noted by Dr Tang, limited information is available about factors affecting the agreement, particularly in non-Western cultures. Hence, such a study seems clearly relevant. The primary reservation regarding this article is the use of overall measures only. These overall measures are composed of items regarding several diverse symptoms and HRQL domains. The use of such overall measures assumes (implicitly if not explicitly) either similar agreement across the symptoms in the measure or that possible differ ences in agreement are unimportant. For a mea sure like the SDS comprising items about 11 important but very diverse symptoms neither of these assumptions seem reasonable a priori. For example, Dr Tang found significantly better agreement regarding the SDS for patients receiv ing pain treatment than for patients who did not [2]. Dr Tang hypothesized (based on Lobchuk arid Kristjanson [3]) that this may be because caregiv ers are better at rating symptoms requiring actions on the part of the caregiver. If this is the case, it seems quite likely that administrating pain medi cation affects the caregiver's ability to assess pain. But why should extra attention from the caregiver regarding pain improve the agreement for other symptoms like problems with 'concentration' or 'outlook'? Without further investigation of the agreement for individual symptoms verifying that administration of pain treatment actually has the same effect for all symptoms, it does not seem likely that this is the case. Hypotheses like this could be investigated much better if the agreement were assessed separately for each symptom; if the agreement regarding pain is significantly better for caregivers who administrate pain medication than for caregivers who do not, this would indicate that the hypothesis was correct. The interpretation for the overall measure seems less clear. For example, how should the finding for the overall measure be used in practice? Does it mean that caregiver reports can be safely used for all symptoms included in the SDS for patients receiving pain treatment, but that caregiver reports are imprecise for all of the symptoms and therefore cannot be used for patients who do not? Findings of no difference in agreement may also be difficult to interpret for an overall measure. Does such a finding mean that the agreement is equally good in the two groups compared for all symptoms or problems included in the measure? Not necessarily. For example, if no differences are found between male and female caregivers for an

Concordance of Quality-of-Life Assessments Between Terminally Ill Cancer Patients and Their Primary Family Caregivers in Taiwan

Physical or cognitive deterioration may hamper the ability or willingness of cancer patients to participate and remain in quality-of-life (QOL) research at the end of life. Use of family caregivers as proxy informants to report patients' QOL has been suggested as a way of resolving the problem of nonresponse bias and nonrandom missing data in end-of-life research. However, there is a dearth of information in the literature about the extent of concordance of QOL assessments between terminally ill patients and their family caregivers outside Western countries. A prospective and descriptive study was conducted to fill the gap in the literature. Results from 114 dyads of Taiwanese terminally ill cancer patients and their family caregivers indicated that QOL assessments from family informants agreed at least moderately well with patients' QOL reports. None of the standardized absolute mean differences for individual items and composite (sub)scales between the 2 respondents exceed the threshold of moderate (>0.50) set by Cohen. Generally, when discrepancies existed, family caregivers held a more negative view of patients' QOL than did patients. At the individual patient level, family caregivers were best able to assess functional dependency, followed by symptom distress, but were least reliable when evaluating the psychological-social-spiritual concerns of patients. The conclusion made by Western researchers that family caregivers can act as a not perfect but reliable alternative source of QOL data for terminally ill cancer patients who are no longer able to speak for themselves is cross-culturally confirmed in this study. It is suggested from the findings that, for family caregivers to function well in their role as proxy informants on the psychological reactions and social/spiritual domains of QOL as well as surrogate decision makers for terminally ill cancer patients in Asian countries, an open and frequent dialogue between terminally ill cancer patients and their family caregivers should become standard.

Congruence of Knowledge, Experiences, and Preferences for Disclosure of Diagnosis and Prognosis between Terminally-Ill Cancer Patients and Their Family Caregivers in Taiwan

Background. Over the last 40 years, studies have shown cultural differences in attitudes toward truth telling at the end-of-life. Nevertheless, the argument that cancer patients from an Asian culture have different preferences about information disclosure that necessitate significantly modifying information disclosure practices has not been validated by direct investigation from patients' points of view. Methods. Six hundred seventeen dyads of patient-designated family caregivers across 21 hospitals throughout Taiwan were surveyed and interviewed by a semistructured interview guide. Percentage of agreement, kappa coefficients, McNemar tests, and paired t-tests were conducted to examine the extent of congruence of knowledge, experiences, and preferences for disclosure of diagnosis and prognosis between the dyads. Results. There were substantial discrepancies in the knowledge and experiences of being informed about the diagnosis and prognosis between Taiwanese terminally-ill cancer patients and their family caregivers (kappa values ranged from 0.08 to 0.44). Cancer patients strongly proclaimed their superior rights to be informed about their disease over their family and preferred their physicians to inform themselves before releasing any information to their family caregivers. Conclusion. The arguments that cancer patients from an Asian culture (i.e., Chinese/Taiwanese culture) have different preferences regarding being informed of their diagnosis and prognosis and that family members have legitimate superior power in decision making could not be supported by data from this group of terminally-ill cancer patients. Physicians need to respect patients' preferences rather than routinely taking the family's opinions into consideration first in the event of disagreement. Equipped with adequate information, terminally-ill cancer patients from Asia may have better opportunities to make end-of-life care decisions that are in accord with their wishes.

Concordance of Preferences for End-of-Life Care Between Terminally Ill Cancer Patients and Their Family Caregivers in Taiwan

There is a dearth of information in the literature about the concordance of preferences for end-of-life care between terminally ill patients and their family surrogates outside the Western countries. The purpose of this study was to examine the extent of concordance in preferences for end-of-life care goals and life-sustaining treatments between Taiwanese terminally ill cancer patients and their primary family caregivers. A total of 617 dyads of patients–family caregivers across 21 hospitals throughout Taiwan were surveyed. Overall agreements on the goals for end-of-life care and preferences for initiating life-sustaining treatments ranged from 62.4% to 96.9% (average: 71.0%). Kappa values for the extent of concordance ranged from 0.13 to 0.46 (average: 0.29), indicating poor to moderate consistency in personal preferences. Family caregivers had a significantly more aggressive attitude toward each examined life-sustaining treatment for their ill family members than the patients' own stated preferences. In societies, such as in Asian countries, where physicians' respect for patient autonomy is frequently subordinate to the power of family, disagreements between a patient and family about end-of-life care may result in the patient's preferences being overridden at the end of life. To effect real change and to gain increased agreement on preferences for end-of-life care, an open dialogue between patients and their primary family caregivers should become standard.

The health status of family caregivers in Taiwan: an analysis of gender differences

Many studies have assessed the impact of caregivers' work activities on the caregiver. There is growing concern about the ever-increasing problems, both physical and physiological, faced by health care workers who provide care for the ill and incapacitated. The aim of the study was to examine what, if any, differences exist between male and female caregivers. This study primarily focused on caregivers who were taking care of a family member. Three hundred and eighty-eight caregivers (280 females and 108 males) were recruited from 16 randomly selected home-care agencies in Southern Taiwan. The participants completed the Chinese Health Questionnaire-12 and the Self-Rated Health Scale. They also completed questionnaires drawn up specifically for the purpose of this study. Compared to the male caregivers, the female caregivers more often reported they suffered from symptoms of lack of well being, a decrease in psychosocial health and overall self-rated health. The results reiterate the importance of considering gender differentiation in the caregiving role. Major differences were found in the extent to which negative health consequences were experienced by the male and female caregivers. The results suggest that caregivers, especially female caregivers, urgently require adequate professional health care assistance in order to reduce the negative physical and physiological effects of caregiving on the health caregiver.

Applying the Transtheoretical Model to Physical Activity in Family Caregivers in Taiwan

The objective of this study was to examine whether specific constructs from the Transtheoretical Model (TTM)(i.e., stages of change, self-efficacy, and perceived benefits and barriers) relative to regular physical activity are applicable to Taiwanese family caregivers. A descriptive and cross-sectional design was used. A convenience sample included 108 primary family caregivers of mentally ill patients receiving home care from a psychiatric hospital in southern Taiwan. After obtaining institutional review board approval and subject's consent, subjects' demographics, stages of change for regular physical activity, self-efficacy, and perceptions of the benefits of and barriers to regular physical activity were assessed through the questionnaire. Subjects in the later stages of the TTM (action or maintenance) had significantly higher levels of self-efficacy than those in earlier stages (precontemplation or contemplation)(p<0.05). No significant difference was found in the level of perceived benefits and barriers across different TTM stages. This study provides partial support for the hypothesized relationships between constructs derived from the TTM. Since this is the first TTM study in Taiwan, continued TTM testing is needed to adequately determine the applicability of the TTM and to identify the most effective theory-based physical activity interventions.

Discrepancy in the preferences of place of death between terminally ill cancer patients and their primary family caregivers in Taiwan

There is a worldwide common preference for dying at home. However, death at home does not come without significant challenges and potential consequences for families. Given the interactive nature of decisions regarding the place of death, the family's perspective is important and needs to be investigated. The purposes of this study were to compare (1) Taiwanese terminally ill cancer patients’ and their family caregivers’ preferences for the patient's place of death; and (2) important factors that are considered in choosing the preferred place of death from both points of view. A total of 617 dyads of terminally ill cancer patients and their family caregivers were surveyed. The majority of both terminally ill cancer patients and their family caregivers preferred to die at home (61.0% and 56.9%, respectively). A higher proportion of the family caregivers indicated a preference for hospital death for the patients. There was a moderate association between the two respondents in the preferences of place of death. Results underscore discrepancies between patients and their families in the importance given to cultural concerns, quality of health care, worries of being a burden to others, lack of availability of families, relationships with health care providers, and being surrounded by the home environment. Effective interventions need to be developed which can lighten the caregiving burden and help families retain dying patients at home, avoid unnecessary re-hospitalizations and unfavorable hospital deaths, and improve accordance with the patient's wishes.