Choice Of Caregivers Research Articles

Low-Acuity Pediatric Emergency Department Utilization: Caregiver Motivations.

Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions. Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. Survey responses and anonymized demographic information were collected. Responses were compared between surveys grouped by respondent age category, relation to child, child's race, insurance type, and ESI levels. Primary reasons given for nonurgent ED visits were perceived urgency (74.2%, n = 441), ED superiority to other locations (23.9%, n = 142), and referral to the ED by a third party (17.7%, n = 105). Of those who cited perceived urgency as a reason, 80.5% (n = 355) wanted to lessen their child's pain/discomfort as soon as possible, but only 13.6% said that their child was too ill to be seen anywhere else (n = 60). Demographic differences occurred in the proportions of respondents citing some of the primary and secondary reasons for bringing their child to the ED. This study highlights 3 key findings. An immediate desire for care plays a key role in caregiver decision making for low-acuity visits. There is potential socioeconomic and racial bias in where care is recommended that needs to be further explored in this region. Cross community interventions that target key reasons for seeking low-acuity care have the highest likelihood of impacting the use of the ED for low-acuity conditions.

Preliminary Evaluation of the Impact of Service Modality on Treatment Outcome and Acceptability Using a Function-Based Behavioral Caregiver Training Program

Few studies have investigated caregiver choice surrounding the modality for behavior therapy for pediatric challenging behavior. This preliminary study sought to (1) understand the factors impacting consumer decisions regarding virtual or in-person behavior therapy and (2) evaluate the associated clinical outcomes using a quasi-experimental design. Forty nine participants received behavioral services for the assessment and treatment of tantrum behaviors. Paired sample t-tests and a one-way ANOVA were conducted to evaluate outcomes. Results suggest choices were most frequently based on caregiver perceptions regarding speed of improvement; modality changes were most associated with failure to make progress. Implications of these findings are discussed.

Meal Planning for Alzheimer's Disease Using an Ontology-Assisted Multiple Criteria Decision-Making Approach

As healthy diets and nutrition are crucial for people with Alzheimer's disease (AD), caregivers of patients with AD need to provide a balanced diet with the correct nutrients to boost the health and well-being of patients. However, this is challenging as they are likely to suffer from aging-related problems (such as teeth or gum problems) that make eating more uncomfortable; the planners, who are usually patients' family members, generally face high pressure, a busy schedule, and little experience. To help unprofessional caregivers of AD plan meals with the right nutrition and flavors, in this paper, the authors propose a meal planning mechanism that uses a multiple criteria decision-making approach to integrate various factors that affect a caregiver's choice of meals for AD patients. Ontology-based knowledge has been used to model personal preferences and characteristics and customize general diet recommendations. Case studies have demonstrated the feasibility and usability of the proposed approach.

The No Surprises Act: A Conservative Band-Aid to Protect Business as Usual.

Hailed as a major reform, the No Surprises Act (NSA) is a profoundly conservative law that aims neither to reform design of insurance, to regulate fees, nor to limit health care spending. The NSA mitigates a perverse but narrow problem: unpredictable and uncontrollable high out-of-pocket bills for individuals who are unable to receive care within their insurance network. However, the NSA neglects to address the broader high medical costs, limited choice of caregivers, and the resulting insecurity and unfairness that characterize American health care. It allows caregivers to extract high payments and insurers to restrict choice of caregivers. Insurers can continue to employ ineffective cost controls that generate unpredictable high out-of-pocket costs for patients-and high levels of denial of payments to doctors and hospitals. The law amputated the most politically and visibly gangrenous consequences of unregulated private insurance in the United States in ways that enable business as usual in private health insurance to persist, subject to unnecessarily complex arbitration rules that magnify administrative waste.

Trends in Adjuvant Chemotherapy Use Among Stage III Colon Cancer in Non-Elderly and Low Comorbidity Patients

BackgroundAdjuvant chemotherapy for stage III colon cancer is underutilized in the United States. The aim of this study was to assess the use of adjuvant chemotherapy in younger and medically fit patients and analyze the socioeconomic factors associated with its utilization. MethodsUsing the National Cancer Database from 2004 to 2015, we selected stage III colon cancer patients between age 18 to 65, Charlson-Deyo Comorbidity Index (CDCI) of 0 or 1, and those that survived at least 12 months after surgery. We then compared patients that underwent surgery only with those that received adjuvant chemotherapy. Multivariable logistic regression analysis was performed to identify variables associated with adjuvant chemotherapy use in the population. Overall survival was estimated by Kaplan-Meier curves. ResultsOf the 48,336 patients that met inclusion criteria, 43,315 (90%) received adjuvant chemotherapy. The utilization of adjuvant chemotherapy increased from 87% in 2004 to 91% in 2015. On multivariable regression analysis, the use of adjuvant chemotherapy was lower among males, Non-Hispanic Blacks and Hispanics, low-grade cancer, left-sided tumors, CDCI 1, those who travel ≥ 50 miles, yearly income < $40,227, and uninsured patients. The most common reason for the omission of adjuvant chemotherapy was the patient or caregiver's choice (40% between 2013 and 2015). The 5-year and 10-year overall survival rates were 76.7% and 63.8% respectively, in those who received adjuvant chemotherapy as compared to 65.1% and 49.3% in those who underwent surgery only (P < .001). ConclusionIn young and medically fit stage III colon cancer patients, most patients received guideline-compliant care in the United States. However, socioeconomic disparities adversely impacted the use of adjuvant chemotherapy. The patient or caregiver's decision was the most common reason for non-adherence to adjuvant chemotherapy and lead to poor survival outcomes. Emphasis should be placed on developing patient-centered strategies to improve adherence to chemotherapy in all patients.

Understanding Drivers of Telemedicine in Pediatric Medical Care.

Purpose: As the demand for telemedicine services continues, greater knowledge about health care delivery preferences can inform high quality, efficient care. The present study sought to evaluate patient and family characteristics that may influence telemedicine utilization, particularly the choice between telephone and video telemedicine visits. Methods: This is a single-site cross-sectional, mixed methods study aimed at identifying factors associated with use of telephone and video telemedicine visits with pediatric patients and their families. Results: Seven hundred seventy-five (n = 775) caregivers completed a survey and 22 caregivers participated in follow-up focus groups and interviews. Findings indicate that female caregivers, those with higher education levels, and those with experience with technology were more likely to choose video telemedicine visits. Qualitative feedback provided several valuable recommendations based on patient/family experiences, which fell into four categories, including scheduling, accessibility, treatment resources, and care coordination. Conclusion: Findings demonstrate that previous experience, familiarity, and technology access may be important drivers in health care modality preference. Key elements that emerged relevant to user satisfaction and overall quality of the telemedicine experience: caregiver choice on visit type (telemedicine vs. in-person), child health care needs, and telemedicine education/training. As society moves toward pay-per-performance and value-based reimbursement, it is imperative that we focus on experience, health care needs, and training to improve patient experience and lower health care costs.

Caregiver COVID-19 vaccination for solid organ transplant candidates

An increasing proportion of transplant centers have implemented a mandate for vaccination against COVID‐19 for solid organ transplant candidates. There has been comparatively little exploration of the ethical considerations of mandating vaccination of a candidate's primary caregiver, despite a high risk of transmission given the close nature of contact between the candidate and caregiver. We examine how a caregiver mandate can improve overall utility in organ allocation, particularly in circumstances where vaccine effectiveness at preventing transmission and serious disease is low among recipients but high in caregivers. Our analysis reveals how sensitive such mandates must be to the evolving circumstances of disease severity, transmissibility, and vaccine effectiveness: as the facts change, the degree of benefit gained and therefore the degree of infringement on access to transplant and caregiver choice that is tolerated will likewise change.

Home-based HIV Testing for Children: A Useful Complement for Caregivers with More Children, Who are Male, and with an HIV Negative Partner.

Expanding index and family-based testing (HBT) is a priority for identifying children living with HIV. Our study characterizes predictors that drive testing location choice for children of parents living with HIV. Kenyan adults living with HIV were offered a choice of HBT or clinic-based testing (CBT) for any of their children (0-12years) of unknown HIV status. Multilevel generalized linear models were used to identify correlates of choosing HBT or CBT for children and testing all versus some children within a family, including caregiver demographics, HIV history, social support, cost, and child demographics and HIV prevention history. Among 244 caregivers living with HIV and their children of unknown HIV status, most (72%) caregivers tested children using CBT. In multivariate analysis, female caregivers [aRR 0.52 (95% CI 0.34-0.80)] were less likely to choose HBT than male caregivers. Caregivers with more children requiring testing [aRR 1.23 (95% CI 1.05-1.44)] were more likely to choose HBT than those with fewer children requiring testing. In subgroup univariate analysis, female caregivers with a known HIV negative spouse were significantly more likely to choose HBT over CBT than those with a known HIV positive spouse [RR 2.57 (95% CI 1.28-5.14), p = 0.008], no association was found for male caregivers. Child demographics and clinical history was not associated with study outcomes. Caregiver-specific factors were more influential than child-specific factors in caregiver choice of pediatric HIV testing location. Home-based testing may be preferable to families with higher child care needs and may encourage pediatric HIV testing if offered as an alternative to clinic testing.

Healthcare seeking behavior for pain in back and extremities in rural population: a community-based estimation of treatment seeking, types and choice of care giver during a period of twelve months in rural Gadchiroli, India

Background Population based studies to understand the current healthcare seeking behavior of the population for pain in back and extremities are lacking from rural India. We studied: (i) healthcare seeking behavior for pain in back and extremities, (ii) types of care providers sought by the community, and the (iii) factors associated with treatment seeking. Methods Two villages were randomly selected from a cluster of 39 villages in the Gadchiroli district of India. Using predetermined criteria, all resident adults ≥ 20 years, were surveyed in January 2010 by the trained community health workers (CHW) by making household visits. Using a structured, pretested questionnaire, they inquired and recorded the history of pain in back and extremities and health care seeking for the same during the previous 12 months. Results Out of 2535 eligible adults in two villages, 2259 (89%) were interviewed. A significant proportion of the participants with back pain and pain in the extremities sought treatment (86.99%). The maximum number of individuals sought care from private providers (64.64%) followed by home remedies (61.64%), government facilities (17.03%), community health workers (CHW) of Society for Education, Action and Research in Community Health (SEARCH) (12.87%), Bengali doctors (5.7%) and traditional healers (6.56%). Almost equal number of participants with any back pain (88.88%) and any extremity pain (88.95%) sought treatment. The care seeking was significantly more for female participants (odds ratio, OR=1.83, 95% confidence interval, CI=1.32–2.5), in case of severe pain (OR=2.0, 95% CI=1.29–3.12) and in the age group 51 to 60 years (OR=2.04, 95% CI=1.14–3.67). Conclusions A significant number of the individuals with back pain and pain in the extremities in rural Gadchiroli seek care, mainly from private practitioners and resort to application of home remedies whereas the care seeking from the public health facilities is considerably less. Hence there is need to provide care for pain in back and extremities in the public healthcare system.

Awareness of cultural practices by skilled birth attendants during pregnancy and birth in Kenya: An interpretive phenomenological study

Cultural capacity among SBAs is recommended in maternal care to promote culturally safe care and meet the childbearing women’s cultural needs and expectations. This study aimed to explore awareness of cultural practices by skilled birth during pregnancy and birth within the Keiyo community in Kenya. MethodsA qualitative phenomenological study was conducted between August to December 2019. A semi-structured interview guide was piloted with two SBAs. Individual interviews and data analysis were conducted iteratively. Eleven participants were interviewed, and saturation of themes was achieved after the ninth SBA. Audio recorded data were transcribed and analysed using ATLAS.ti Software version 8.4.4 (1135) that followed Van Manen’s five steps of thematic analysis. FindingsThe three themes that emerged from an inductive and iterative data analysis process were SBAs familiarity with cultural practices, SBAs awareness of cultural practices, women’s expectations of clinical care and challenges to establishing a more collaborative relationship between SBAs, traditional birth attendants (TBAs) and childbearing women. ConclusionThe SBAs awareness of cultural practices was highlighted through relationships formed during care engagements. This awareness revealed a potential indicator for women’s choice of caregiver. Awareness of threats to cultural safety and fear of disclosure potentially created mechanisms to promote more collaborative care. A broader scope of skilled care approaches requires heightening maternity care providers’ cultural sensitisation to reduce gaps in women’s cultural needs and expectations.

Care2Caregiver: A Peer Support Helpline for Caregivers of Persons Living With Dementia

Caregivers of persons with Alzheimer’s disease and Related Dementia (CADRD) provide a significant amount of support to their family members, however, experience many challenges and stress that impacts their quality of life, emotional and physical well-being. They also have difficulty accessing services. Peers supporters, or CADRD with specialized training, are an important resource to help alleviate stress related to caregiving and focus on wellbeing, yet few studies have examined peer support. Our retrospective cohort study examined four years of data collected from a peer support helpline for CADRD in a northeastern state. Data included: demographics, presenting issues, services provided to assess for changes across time and call frequency. The Peer Specialists were CADRD who received specialized training and supervision to provide telephonic peer support. Caregivers were primarily female, and the average age of caller increased significantly over time. Issues related to personal emotional wellbeing was the primary reason for the call. The primary type of support provided was peer support interactions, follow-up calls, and links to resources focused on caregiver well-being. Callers reported distress from offering care to multiple recipients. Electronic follow-up (e.g. email and chat) increased over time. Peer support helpline programs have the potential to address the practical, physical, social and emotional needs of CADRD in the location of the caregiver choice. This model has potential to reach the growing number CADRDs via an array of web-based services including chat, email and online support, which can help overcome transportation and other logistical barriers to support.

Primary Caregiver Relationships for Advanced Heart Failure Therapy Differ Based on Sex and Race and Predict Eligibility

Introduction Use of heart transplant (HT) and left ventricular assist device (LVAD) are considered standard of care for eligible patients with end-stage heart failure (HF). In assessing eligibility, caregiver assistance is an important consideration in a patient's candidacy. While studies have shown that individuals without caregivers have worse survival outcomes, few studies have demonstrated how caregiver relationships differ based on sex and race, and whether that impacts eligibility for HT/LVAD. Hypothesis Women and Black patients are less likely than men and non-Black patients, respectively, to have a spouse listed as primary support, which may adversely affect eligibility for HT/LVAD. Methods We identified all patients (N=534) evaluated at Emory University for HT/LVAD from 2011 to 2016. Stanford Integrated Psychological Assessment for Transplant (SIPAT) scores were compared by sex and race using Wilcoxon rank-sum tests. The outcome of HT/LVAD evaluation according to primary caregiver relationship was compared by sex and race using X2 analysis. Multivariable logistic regression was used to determine the association between primary caregiver and HT/LVAD eligibility according to sex and race, adjusted for age, HF etiology, insurance, inotrope dependence, bilirubin, albumin, allosensitization, CKD stage, and SIPAT score. Results The mean age of the cohort was 52 ± 13 years; 171 (32%) were women and 294 (55%) were black. Total SIPAT scores did not vary significantly between men and women or blacks and non-blacks, regardless of primary support person. Women were less likely to have a spouse as primary support, and were more likely to have a parent or child as primary support (Table). Black patients were less likely to have a spouse as primary support, and were more likely to have a parent as primary support. In sex-stratified multivariable models, the choice of primary caregiver did not affect eligibility for HT/LVAD for women (P=0.8) or men (P=0.4). In race-stratified multivariable models, blacks with a parent as primary caregiver were less likely to be eligible for HT/LVAD (OR=0.17, 95% CI 0.03 - 0.97, P=0.04), however the primary caregiver was not associated with eligibility for HT/LVAD in non-black patients (P=0.9). Conclusion The choice of primary support person has a modest effect on decreasing eligibility for black patients being evaluated for advanced HF therapies, but not for women. More research is needed to determine unique barriers to advanced HF therapies for female and black patients.

Factors associated with preferences for elderly care mode and choice of caregivers among parents who lost their only child in a central China city.

It is forecasted that the figure of families in China who lost their only child will reach 10 million by 2035. Traditional Chinese culture places these families in a particularly disadvantaged position for elderly care. It is quite important to understand the elderly care needs of the parents. The cluster sampling method was used to select the parents who lost their only child in Wuhu city, China. Univariate and multivariate logistic regression analysis models were carried out to analyze factors influencing the parents' preferences for elderly care mode and choice of caregivers. The Geriatric Depression Scale score (P < 0.001) was significantly associated with the parents' preferences for elderly care mode. Parents with different sex, marital status and grandchildren status had different preferences for their choice of caregivers. The number of chronic diseases and Geriatric Depression Scale scores were significantly associated with preferences for choice of caregivers. These parents should have a preferential policy of check in to a nursing home and simplify the check-in procedure. The parents should receive prompt for depression and stay in the community for elderly care. The government should guarantee that spouseless parents have priority in enjoying nurse/nursing home worker services. The government should support the development of volunteer services. Geriatr Gerontol Int 2020; 20: 112-117.

Caregiver Choice and Caregiver Outcomes: A Longitudinal Study of Irish Spousal Dementia Caregivers.

BackgroundThe perception of choice in becoming a caregiver may impact on caregiver psychological and physical health. We determined the proportion of spousal dementia caregivers who felt they had a choice, and examined whether lack of choice in taking up the caregiving role and the perceived degree of choice in caregiving predicted caregiver health and wellbeing and care-recipient placement in long-term care at 1-year follow-up.MethodsWe performed secondary analyses of data from DeStress, a longitudinal study of 251 spousal dementia caregivers in Ireland. We used multivariate logistic and linear regression analyses to examine whether lack of choice (a dichotomous item) and/or the perceived degree of choice (a 9-point scale) at baseline predicted caregiver health (number of chronic health conditions; self-reported health) and wellbeing (e.g., burden, anxiety, depression, stress, and positive aspects of caregiving) and care status (continued care at home or placement in long-term care) at follow-up.ResultsThe vast majority of caregivers (82%) reported that they had no choice in taking up the caregiving role. Nevertheless, nearly three-quarters (74%) responded above the midpoint on the rating scale (Mean = 6.82, SD = 3.22; Median = 9; Mode = 9), indicating they provided care voluntarily. Caregivers who reported a greater degree of choice were more likely to still be providing care at home at follow-up and to identify benefits from providing care. Neither choice nor degree of choice predicted any other caregiver outcomes.ConclusionFor the vast majority of spousal dementia caregivers, taking up the caregiving role is not perceived as a choice; yet, most report performing this role voluntarily. Thus, facilitating greater choice may not necessarily diminish the key contribution family caregivers make to the care system. Although we found no evidence that caregiver choice predicted more positive caregiver health and wellbeing, the perception of choice is important in and of itself, and may benefit caregivers by facilitating the identification of positive aspects of care and be a factor in delaying care-recipient placement in long-term care. Future research should be especially mindful of how caregiver choice is assessed and how this may affect the resulting prevalence of choice.

Clinical trials in low-resource settings: the perspectives of caregivers of paediatric participants from Uganda, Tanzania and Kenya.

ObjectivesVaccine clinical trials in low‐resource settings have unique challenges due to structural and financial inequities. Specifically, protecting participant and caregiver autonomy to participate in the research study can be a major challenge, so understanding the setting and contextual factors which influence the decision process is necessary. This study investigates the experience of caregivers consenting on behalf of paediatric participants in a malaria vaccine clinical trial where participation enables access to free, high‐quality medical care.MethodsWe interviewed a total of 78 caregivers of paediatric participants previously enrolled in a phase II or III malaria vaccine clinical trial in Uganda, Tanzania and Kenya. Interviews were qualitative and analysed using a thematic framework analysis focusing on the embodied caregiver in the political, economic and social reality.ResultsCaregivers of participants in this study made the decision to enrol their child based on economic, social and political factors that extended beyond the trial into the community and the home. The provision of health care was the dominant reason for participation. Respondents reported how social networks, rumours, hierarchal structures, financial constraints and family dynamics affected their experience with research.ConclusionsThe provision of medical care was a powerful motivator for participation. Caregiver choice was limited by structural constraints and scarce financial resources. The decision to participate in research extended beyond individual consent and was embedded in community and domestic hierarchies. Future research should assess other contexts to determine how the choice to participate in research is affected when free medical care is offered.

Parental perceptions and drinking water source among pediatric population in the United Arab Emirates

Aims: The aim of the study is to determine the water source used for drinking and cooking purpose by the pediatric population in the United Arab Emirates (UAE). To ascertain the underlying factors influencing the parental choice for selecting tap water or bottled water. The study was also done to evaluate whether demographic factors have an influence on the parental choice of water consumption source.Materials and Methods: A total of 200 parents who had children aged between 3- and 15-year-old were chosen for this randomized cross-sectional study. The parents of the selected children were given a prewritten questionnaire consisting of 12 questions in four different languages. The questionnaires documented sociodemographic characteristics, water consumption practices, and the rationale for choosing bottled water and tap water. The responses were analyzed using descriptive statistics and a Chi-square test for a single proportion. Results: Majority of the parents in this study preferred bottled water to tap water for drinking and cooking purposes. About 84% of the parents opted bottled water for drinking and 57% selected bottled water for cooking at home. The consumption of tap water for drinking purpose from school and home was only 13% and 16%, respectively. Parental educational background and household income did not affect their selected source of water. A Chi-square test of independence conducted to investigate possible association between source of water and its purpose for drinking and cooking revealed that the source of water (tap/bottled water) was dependent on its purpose. Conclusion: A greater percentage of the UAE pediatric population utilized bottled water for drinking at school and home. The perceptions about the quality and safety of tap water had a great effect on the caregiver's choice on children's water consumption habits. The demographic factors such as socioeconomic status and parental education had no influence on the source of water used for drinking purpose.

Women's choice of maternal healthcare in Parung, West Java, Indonesia: Midwife versus traditional birth attendant

BackgroundIn the 1990s, the Indonesian government launched programmes to train traditional birth attendants (TBAs) and increase the number of midwives. AimTo identify and compare the factors that influence women's choice of a midwife or a TBA for maternal healthcare in Indonesia. MethodsThis study used a descriptive design for comparing women's choice of maternal healthcare. The participants were (1) married women, (2) experienced birth within two years, (3) living in a rural or urban village, and (4) capable of communicating in the Indonesia language. Three instruments were used: (1) traditional belief questionnaire, (2) preference for caregiver questionnaire, and (3) women-centered care (WCC) questionnaire which measured women's perceptions of care that they received during pregnancy. FindingsA total of 371 women participated in this study. All these subjects answered based on their most recent birth within the last two years. Of the 371 women, 207 (55.8%) chose a midwife and 164 (44.2%) chose a TBA for giving birth. Women choosing midwives were generally satisfied and perceived receiving WCC. Factors determining choice were (1) women's background, (2) perception of WCC, (3) satisfaction, (4) choice of antenatal care (ANC), (5) family encouragement, and (6) traditional beliefs. DiscussionThe choice of caregivers was determined by not only education, parity, usual source of healthcare payment, and family encouragement but also traditional beliefs. ConclusionIndonesian women's choice of a midwife instead of a TBA for their maternal healthcare resulted in a higher satisfaction of care and more ANC visits.

Malaria and agriculture: Evidence of relationship and labour/income loss among rural rice-farming households in Nigeria

The present study examines relationship between malaria and labour/income loss in rice production. Also, factors influencing sickness absence and choice of care provider among rice farming households in Nigeria were analyzed. Multistage sampling technique was employed in data collection where 570 rice farmers were selected. Data were analyzed using descriptive statistics, Tobit regression model and Multinomial Logit model (MNLM). Marital status, number down with malaria, malaria perception waiting time, choice of caregiver and hired labour availability significantly influenced sickness absence rate, while the choice of malaria care provider was influenced by household size, education, clinic distance, treatment cost, and malaria perception for public hospital over self-medication. More clinics should be provided in the hinterland for prompt treatment of malaria. Policies to address rice output increase or rice farmers’ productivity enhancement should be in consonance with health policies in rural Nigeria where the majority of the farmers reside.

The Influence of Evolving Confucian Beliefs in the Selection of Proxy Decision-Makers at the End of Life in Singapore

In Singapore, care of patients is often seen as part of the duty of the family unit with care decisions and treatment costs determined by the eldest son. Rising costs and increasing care needs, however, have led to the diversification of care roles. Understanding how these roles are determined is critical to decision-making, better patient care and effective communication with the family. This study seeks to explore the factors behind the selection of the main caregiver, who provides the majority of physical care to the patient, and the decision-maker, who is tasked with deciding on treatment plans. Twenty-one oncologic patients and caregivers attending an ambulatory treatment unit at a tertiary oncology centre viewed a video vignette and were asked about the suitability of the three children who suggest different options to care of their mother following her diagnosis of metastatic terminal cancer. Participants were also asked what factors they considered when selecting a surrogate. Contrary to traditional reliance upon gender roles to determine care roles and duties, nearly 60% of caregivers and 40% of patients prioritised the availability, willingness and capability of family members, and their financial and personal situations in determining their choice of caregiver and surrogate decision-maker. The shift away from gender-determined roles stems from the evolving nature of Confucian beliefs that are influenced by practical and sociocultural considerations. These findings remind healthcare professionals that gender stereotypes have begun to fade and that they should continually review familial and cultural beliefs in care determinations at the end of life.

An exploration of caregiver choice through the lens of Sartrean existentialism.

There are innumerable social and ethical factors which affect one's decision to become an informal caregiver for someone with chronic illness. The existential philosophy of Jean-Paul Sartre provides unique insight into human motivation and choice. The purpose of this paper was to examine the social and ethical influences on the individual's decision to become a caregiver through the lens of Sartrean existentialism and discuss how this unique philosophy can advance nursing knowledge. The factors affecting one's choice to become a caregiver were considered using the Sartrean existential concepts of The Other, human freedom, choice, bad faith, shame and authenticity. When explored through the perspective of Sartrean existentialism, the choice to become a caregiver is strongly influenced by fear of judgement from The Other and the resulting sense of social obligation and shame. However, the interaction with The Other often results in the loss of authenticity through the pursuit of bad faith. To avert bad faith, potential caregivers must act authentically by exercising their freedom to choose and by choosing an action for its own sake and not for some extraneous purpose. The results of this philosophical inquiry contribute to nursing knowledge by providing a unique, alternative perspective by which nurses may understand the choices of potential caregivers and support them in making authentic decisions. This perspective may provide a foundation for theory development and promote further nursing knowledge which will improve caregiver health and well-being.