Caregiver Understanding Research Articles

The impact of a student pharmacist‐led inpatient medication counseling initiative on medication safety in kidney transplant recipients

AbstractIntroductionEngaging student pharmacists as pharmacist extenders to facilitate medication education may represent a unique pathway for preventing medication safety issues and mitigating downstream consequences in the high‐risk kidney transplant (KTX) population. The aim of this study was to describe the implementation and impact of a student pharmacist‐led counseling initiative designed to promote patient and caregiver understanding of transplant medications.MethodsThis is a single‐center, retrospective quality improvement initiative comparing adult KTX recipients who received interventional student pharmacist‐led education vs a historical cohort. Data on clinical outcomes, including the incidence of medication errors (MEs), adverse drug events (ADEs), and readmissions, was extracted from the patient's electronic medical record. In the intervention cohort, attendee satisfaction was assessed based on responses obtained from surveys distributed to patients and caregivers on the day they attended the student pharmacist‐led class.ResultsA total of 311 KTX recipients were included in this analysis; 149 in the intervention cohort and 162 in the historical cohort. Patients in the intervention cohort experienced more MEs than those in the historical cohort (31 vs 11; P < .001). Rates of ADEs within the first 30 days post‐transplant were comparable across cohorts (56 vs 52; P = .406). No significant difference in readmissions at days 7, 14, and 30 was observed between groups. Attendee satisfaction was high across all survey response fields.ConclusionThe results of this study demonstrate that KTX recipients who participated in student‐pharmacist led medication counseling had comparable rates of ADEs and readmissions to those who did not, but were more likely to experience MEs. Future research is needed to explore the role of structured medication counseling and the utility of student pharmacists in the clinical setting.

Caregivers’ Language and Emotions Around Care

Caregiving encompasses a range of roles and activities, but not all people providing care identify as “caregivers.” Understanding the vocabulary and emotions that caregivers have should first, contribute to an understanding of caregiving and caregivers per se, and second, aid in communicating with them more effectively. Analysis of survey data from members of the MIT AgeLab Caregiver Panel shows variance in self-identification as caregivers and in language and emotions around caregiving, reflecting diversity in the care experience, but consensus around the core concept of a caregiver. This presentation will report on how caregivers’ relationships, gender and care tasks affect their language and identify a caregiver experience-identity gap: a space between what caregivers do and what they report. We highlight how an understanding of caregivers’ experiences of what they do – as opposed to a catalog of tasks they do – may be more important for understanding their experience of strain.

Aspects of Grit Among Dementia Family Caregivers

Dementia family caregivers often show deep devotion and a strong sense of purpose and duty toward their relatives needing care. The concept of grit, which includes aspects of commitment, purpose, perseverance, and resilience, is a novel theoretical approach to expanding understanding of dementia family caregiver strengths amidst the challenges they face. Multiple psychosocial and contextual factors are likely to interact with and influence grit among these caregivers. This symposium addresses commitment to the family dementia caregiver role, willingness to embrace the stressful work of caregiving, and perseverance in finding ways to sustain caregiving roles under typical and adverse circumstances. Blieszner focuses on associations between grit and stressors and strains that challenge caregiver well-being and jeopardize continued caregiving. Wilks considers the impact of spiritual support on sustaining resilience among Caucasian and African American dementia caregivers. McCann explores caregivers’ responses to changes in informal support and social interactions available to assist with home care tasks over the course of the COVID-19 pandemic. Albers examines the strengths and resources caregivers draw upon to manage the challenges of caring for and supporting a relative in long-term residential care during the pandemic. Collectively, these presentations provide new insights into the range of influences on aspects of grit and circumstances in which grit sustains caregiving. Discussant Margrett considers the value of the concept of grit for furthering understanding of caregivers’ abilities to manage typical and unique challenges in their caregiver roles and offers suggestions for future research and interventions to enhance grit among dementia family caregivers.

Perceived Neighborhood Disorder, Social Cohesion, and Depressive Symptoms among Spousal Caregivers

Most prior research on caregivers’ mental health focused on individual or household factors, we know much less about the influence of neighborhood factors on mental health of spousal caregivers. The current study fills the gap in our knowledge by examining the association of neighborhood characteristics (i.e., perceived neighborhood disorder and neighborhood social cohesion) and depressive symptoms among spousal caregivers. We used data from 2006 to 2016 waves of the Health and Retirement Study, which includes 2,362 spousal caregivers. Negative binomial regression models were estimated to examine the association of perceived neighborhood disorder and neighborhood social cohesion with depressive symptoms. A greater perceived neighborhood disorder was associated with higher CES-D scores, which indicates more depressive symptoms. On the other hand, a higher level of neighborhood social cohesion was associated with lower CES-D scores. When they were included in the same model, the association between neighborhood disorder and depression disappeared, while respondents who reported higher levels of neighborhood social cohesion continue to exhibit lower CES-D scores than those lived in less cohesive neighborhoods. This study highlights the importance of neighborhood contexts in understanding caregivers’ well-being. Findings of this study suggest that neighborhood social cohesion may attenuate the negative effects of neighborhood disorder. Therefore, enhancing positive characteristics of the neighborhood may promote well-being of spousal caregivers.

Perceived Neighborhood Disorder, Social Cohesion, and Depressive Symptoms among Spousal Caregivers

Although individual sleep characteristics are related to frailty, these characteristics do not occur separately. A multidimensional measure of sleep might provide a better estimation of frailty compared to isolated sleep characteristics. This study investigated the association of a multidimensional measure of sleep health with frailty and examined whether such relationship differed by sex. Data were from the Taiwan Longitudinal Study on Aging (2011), a survey with a nationally representative sample of Taiwanese older adults (N=2,015). Frailty was defined using the Fried-criteria. Self-reported sleep during the past month was used to conceptualize the five sleep health dimensions in the SATED model (satisfaction-alertness-timing-efficiency-duration; higher scores representing better sleep health). Their relationship was estimated using logistic regression analysis adjusting for sociodemographic (age, sex, education), health (chronic conditions, cognitive function, pain, depressive symptoms [excluding items overlapping with frailty and sleep]), and lifestyle (drinking, smoking, exercise) characteristics. The results showed that having a better sleep health composite score was significantly related to lower odds of being frail in both sexes adjusting for sociodemographic information. Such effect remained significant among females but not males after adding health and lifestyle characteristics to the models. Sleep satisfaction and daytime alertness in both sexes and sleep duration among females were significantly associated with frailty adjusting for sociodemographic information. Only alertness among males was significantly related to frailty in model with all covariates. Our findings show that having a better sleep health across multiple dimensions is related to a lower risk of being frail, and the association differs by sex.

A Scoping Review of Youth Caregivers: Addressing the Needs of This Growing Population

The FL-REACH intervention for families in early stage post-dementia diagnosis was originally adapted from the REACH II program for use in an outpatient clinic. Pandemic restrictions forced an adaptation to a teletherapy format. The timing of changes allowed comparison of caregivers who participated in clinic (n=10), switched modalities mid-treatment (n=7), and participated as teletherapy (n=14). Groups were similar in age range, gender, and relationship, with both spouses and adult children participating. Participants in the fully online group were more likely than others to have high school or trade school education than to have graduated from college. All participants in the in-person and hybrid groups had incomes over $40,000/year, while 36% of the online sample had less household income, were more likely to be Hispanic-identifying (43% versus 6%), and had higher burden scores (M=41.43 versus M=32.56 in person, M=29.86 hybrid) and lower preparedness scores (M=19.86 versus M=22.90 in person, M=28.14 hybrid) at baseline (p<.05). The intervention proceeded with the same intervention dosage (8 hours total), and outcomes were essentially comparable, with all groups showing statistically significant improvement on measures of preparedness, burden, and risk. While in-person intervention helped strengthen relationships with the medical team, inclusion of family via telehealth provided opportunity for a more culturally responsive and inclusive engagement, although there remain questions regarding reasons for differences at baseline. Identification of differences in key outcomes for direct comparisons between in-person, hybrid, and teletherapy interventions are limited in the evidence base, making this a unique study at an important moment in time.

The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia

Grandparents are increasingly providing extensive and custodial care for their grandchildren. Many factors have contributed to a societal rise in caregiving among grandparents, including addiction, incarceration, dual-income families, and the cost of childcare. Past work has highlighted positive effects of grandparenting (e.g. reduced dementia risk); however, research is limited that examines the day to day challenges grandparent caregivers experience. The goal of this research was to examine daily experiences of stressors, positive events, physical symptoms, and daily mood of grandparent caregivers. Participants (n=18 grandparent caregivers) filled out a diary survey for five consecutive days that measured daily stressors and positive events. A total of 90 diaries were completed. Stressors were reported on 97.6% of days. Multilevel analysis examining emotional and physical reactivity to daily events showed that, controlling for age and gender, on days when participants reported more stressors than average, they reported higher negative affect (p=.019), lower positive affect (p=.003) and more physical symptoms (p=.002). Positive events were not significantly associated with daily mood or daily physical symptoms. Overall, the findings supported the hypothesis that grandparent caregivers experience emotional and physical reactivity to the daily challenges they experience. Future research should examine resources and supports to reduce the impact of daily stressors, as well as the particular challenges among underrepresented groups, particularly Black and Latino grandparents, who provide disproportionate levels of care for their grandchildren. The current study highlights the potential vulnerability and daily needs for support among grandparents who provide regular and custodial care for their grandchildren.

The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia.

Anticipatory grief is the process of experiencing normal bereavement before the physical death of a significant person. To date, anticipatory grief has been related to higher levels of caregiver depression, anxiety, subjective burden, and poorer problem solving. Additionally, higher levels anticipatory grief are observed in caregivers of those with Alzheimer’s Disease and Related Dementias (ADRD) compared to caregivers of those with mild cognitive impairment, implying a relationship between disease severity and caregiver anticipatory grief. Analyses were performed on data for ADRD caregivers (n=56) enrolled in the IU Telephone Acceptance and Commitment Therapy for Caregiver (TACTICs) trial; an RCT evaluating an ACT intervention for ADRD caregivers with anxiety. Inclusion criteria included identifying as the primary caregiver of an ADRD patient, and clinically significant anxiety (GAD7 score >10). The average age of caregivers was 61.9 years, 41.1% were spouses, 83.9% were white and 14.3% were black. Mean anticipatory grief scores were notably higher (84.6) compared to the previously reported means across the literature (74.9). Using multiple regression models, we determined a caregivers’ anticipatory grief, as measured by the anticipatory grief scale, is not significantly associated with the patients’ dementia severity, as measured by the Dementia Severity Rating Scale (DSRS) (p=0.66), Results revealed that higher levels of caregiver burden, as measured by the Zarit Burden Index, are significantly associated with more anticipatory grief (p< 0.01). Understanding these relationships contributes to a better understanding of ADRD caregivers, identifying “high-risk” caregivers, and informing future interventions and care.

Embodying the Aging Experience: How Virtual Reality Is Transforming Medical and Nursing Education

Virtual reality (VR) has long been standard in healthcare education. Recent advances in VR hardware and software applications have coalesced to allow for higher fidelity, more highly realistic simulations that are also deployable at scale -- not just in highly specialized, single location simulation labs. In tandem, there has been an examination in both the corporate and academic sectors around the efficacy of VR training and learning. While VR has been long proven to be effective in training students and workers in hard skills, its lack of realism has been a barrier to explore efficacy in simulations related to soft skills and emotional intelligence. This symposium will discuss the implementation of virtual reality “labs”, where learners embody in a live 360 film environment the first-person point of view of an older adult -- interacting with gaze, voice, and natural hand motions – into four university’s medical and nursing curriculum. Lab outcomes include decreased ageism and stereotyping, and increased empathy, sensitivity, cultural competency, and disease knowledge. The first paper reports outcomes of increased understanding, comfort, compassion and empathy of students and informal caregivers after experiencing various labs. The second discusses comparative data on knowledge and attitudes of medical students experiencing the virtual labs individually vs. the group distance mode. The third reports the results of an initial study on how embodying an older adult with sensory impairment affects participant empathy using a standardized scale. The fourth discusses how one university transitioned to delivering immersive labs to nursing students remotely during COVID19.

A Scoping Review of Youth Caregivers: Addressing the Needs of This Growing Population

IntroductionEast Asian Americans are considered a hard-to-reach population in the field. Existing resources are not inclusive of Korean family caregivers, and therefore, a community support system may be required for this ethnic group.MethodsWe conducted a telephone-based survey and in-depth interview with Korean family caregivers of persons with dementia (N=36; Mean age: 63.3) to examine their physical and social environments.ResultsMost caregivers (58%) co-resided with their care recipients. Those providing care with limited assistance from others showed greater financial hardship (p=0.03) and interference with employment (p=0.03). Job interference was further related to higher levels of caregiving burdens (p=0.01). The services used most were senior center services (25%) and in-home care services (17%), while desired services included health promotion and disease prevention services (50%) and culturally appropriate or medically tailored home-delivered meals services (31%). Caregivers socialized with others using a multi-messaging app (i.e., KakaoTalk) with others. About 74% of them addressed they used KakaoTalk always (52%) or often (22%), and nearly half of them (47%) said they searched for caregiving information online. Findings from our qualitative interviews confirmed positive attitude toward the use of technology. Korean family caregivers showed a lack of knowledge of not only existing community-based resources but also the disease-related information, particularly regarding early-stage support and home safety.ConclusionIt is critical to develop a community education program that reflects their unique physical and social environment conditions, potentially through technologically delivered interventions, for outreach and engagement for Korean family caregivers of persons with dementia.

Connecting the Dots: Pain Mental Models of Spousal Caregivers of Veterans with Dementia and Pain

Abstract Pain is prevalent among persons with dementia (PWDs), yet often goes underrecognized and undertreated. Exploring caregivers’ pain mental models may provide valuable insight into how they conceptualize pain, and how such conceptualizations affect their identification of and response to PWDs’ pain. We identified and described the pain mental model(s) of spousal caregivers of community-dwelling veterans with dementia and pain through a secondary qualitative thematic analysis of recordings of a psychosocial intervention aimed at preventing aggression in PWDs with pain. Thirty female spousal caregivers (11 Black, 10 non-Hispanic White, and 9 Hispanic) comprised the present sample. Two themes were identified: Pain Assessment Beliefs and Knowledge (PA) and Pain Management Beliefs and Knowledge (PM). In our proposed mental model framework, PA and PM affect the ways caregivers answer two PA-related questions (Is there a problem?, Is this problem pain?) and three PM-related questions (Is the pain treatable?, Is it worth treating?, How do I prefer to treat it?). Caregivers are moved to action when they “connect the dots” by identifying a problem in PWDs’ behavior, labeling the problem as pain, and identifying a response (i.e., a treatment approach) they consider worth trying. Disconnects in caregiver understanding of PWDs’ behavior are common in this sample, and predictably lead to inaction. The proposed mental model provides further explanation about how caregivers do or do not synthesize and apply pain knowledge and experience, allowing for the identification of potential areas of intervention (e.g., pain psychoeducation) to improve pain treatment for the PWDs under their care.

Caregiving for Persons Living With Dementia in the New Normal: Family Caregiver’s Perspective.

The COVID-19 pandemic poses serious physical and mental health risks for older adults worldwide. To develop culturally and contextually congruent services to mitigate these risks requires understanding their stress and coping processes, which remain understudied in Latin America. This study examines qualitative data from 51 adults aged 60 and over who participated in an ongoing study of older Puerto Ricans’ knowledge, attitudes, and practices about COVID-19. Trained interviewers collected the data by telephone from January to August, 2021. Two-thirds of participants were female, 60% had less than high school education and 90% had poverty-level incomes. Drawing on Lazarus and Folkman’s Stress and Coping Theory, we conducted a thematic analysis of responses to open-ended questions about the nature and extent of COVID-related stressors, stress management, and meanings and guidance they had gleaned from their experience. Participants perceived the pandemic as an added threat to ongoing chronic stressors (e.g., Hurricane Maria, poverty, political instability); disruptions in daily routines, family cohesion, and grief and loss processes; and increased isolation and loneliness. They reported using cognitive, behavioral, socioemotional and spiritual coping, including positive thinking, keeping occupied, relaxation, religious practices and, in a few cases, social media. Participants highlighted a revitalized appreciation for emotional qualities of relationships, freedom and life in general. Consistent with our guiding theory, cultural, contextual, religious, and socio-political factors shaped their appraisals of stress and their coping strategies. Future research should examine how these practices relate to health outcomes and quality of life and how they can inform effective, appropriate interventions.

“Cinderella Men”: Husband- and Son- Caregivers for Elders with Dementia in Shanghai

Traditionally, women had the day-to-day responsibility for eldercare. However, social changes have created alternatives for men to take on what is generally considered a “female duty.” Particularly, as the prevalence of dementia has increased in China, men are increasingly becoming the primary caregivers for their kin. Yet, we have limited understanding of male caregiving. Based on twenty months’ ethnographic study of 60 men taking care of a relative with dementia, this paper examines motivations, practices, struggles and strategies of male caregivers. While acknowledging the gendered nature of caregiving, I argue that eldercare goes beyond solely social construction of gender roles and power asymmetries between males and females. Men—both husbands and sons—who engage in caregiving are motivated by love, affection, moral obligation, reciprocity based on past assistance, and property inheritance. Male caregivers’ care practices and their responses toward challenges vary from case to case, yet, these differences have less association with gender identity but more with cohort variations. The expanding home roles of male caregivers call attention to the social transformation of gendered care practices in China and beyond.

Awareness, Knowledge, and Preferences of United States (US) Patients with Chronic Lymphocytic Leukemia (CLL) and Their Caregivers Related to Finite Duration (FD) Therapy and Minimal (Measurable) Residual Disease (MRD)

Awareness, Knowledge, and Preferences of United States (US) Patients with Chronic Lymphocytic Leukemia (CLL) and Their Caregivers Related to Finite Duration (FD) Therapy and Minimal (Measurable) Residual Disease (MRD)

A Comprehensive Assessment of Informal Caregivers of Patients in a Primary Healthcare Home-Care Program.

Studies of the characteristics of informal caregivers and associated factors have focused on care-receiver disease or caregiver social and psychological traits; however, an integral description may provide better understanding of informal caregivers’ problems. A multicenter cross-sectional study in primary healthcare centers was performed in Barcelona (Spain). Participants were a random sample of informal caregivers of patients in a home-care program. Primary outcomes were health-related quality of life and caregiver burden, and related factors were sociodemographic data, clinical and risk factors, social support and social characteristics, use of healthcare services, and care receivers’ status. In total, 104 informal caregivers were included (mean age 68.25 years); 81.73% were female, 54.81% were retired, 58.65% had high comorbidity, and 48.08% of care receivers had severe dependence. Adjusted multivariate regression models showed health-related quality of life and the caregivers’ burden were affected by comorbidity, age, time of care, and dependency of care receiver, while social support and depression also showed relative importance. Aging, chronic diseases, and comorbidity should be included when explaining informal caregivers’ health status and wellbeing. The effectiveness of interventions to support informal caregivers should comprehensively evaluate caregivers when designing programs, centering interventions on informal caregivers and not care receivers’ conditions.

Family Caregivers' Experience of Patients With Delirium in Critical Care Units: A State-of-the-Science Integrative Review.

Delirium as a sudden cognitive and behavioral change can be traumatic for family caregivers. An understanding of family caregivers' experiences with delirium in their loved one in an intensive care unit (ICU) will help clinicians provide family-centered care. To explore the impact of delirium on, and the needs of, family caregivers of ICU patients with delirium. A comprehensive search was done of literature in the PubMed, CINAHL, and Scopus databases published from 2000 to 2020. Primary studies written in English and done in critical care settings were included. Studies that did not focus on the family experience of delirium were excluded. Additional studies were identified by reviewing the reference lists of selected articles. Evidence was synthesized, and common themes were identified. Among 210 studies, 7 were included after irrelevant and duplicate studies had been removed. Findings were categorized as (1) psychological impacts of a patient's delirium on family caregivers and (2) family caregivers' needs. Common psychological impacts included anxiety, depression, concern, fear, anger, uncertainty, shock, insecurity, and disappointment. Family caregivers reported needing informational and emotional support from, and effective communication with, health care professionals. Family caregivers' health is crucial to ensuring the effectiveness of family engagement in delirium management. Future studies should consider family caregiver characteristics that could be used to predict psychological symptoms when caregivers are exposed to a patient's delirium and explore whether specific types of delirium cause more psychological impacts and needs among family caregivers than other types of delirium cause.

"Walking a tightrope": A grounded theory approach to informal caregiving for amyotrophic lateral sclerosis.

Informal caregivers, mainly family members and friends, provide supportive and palliative care for people with amyotrophic lateral sclerosis (ALS) during their terminal disease course. Informal caregiving for people with ALS continues towards palliative care and end‐of‐life care with the progression of the disease. In this study, we provide a theoretical understanding of informal caregiving in ALS utilising 23 semi‐structured interviews conducted with informal caregivers of people with ALS (pwALS) in Switzerland. Due to the expected death of the care recipient, our grounded theory approach outlines informal caregivers’ caregiving work as an effort to secure a balance amongst different caregiving activities, which feed into the final stage of providing palliative care. Overall, our theoretical understanding of ALS informal caregiving work encompasses the core category ‘holding the balance’ and four secondary categories: ‘Organising support’, ‘being present’, ‘managing everyday life’ and ‘keeping up with ALS’. The core category of holding the balance underlines the significance of ensuring care and normalcy even as disease progresses and until the end of life. For the informal caregivers, this balancing act is the key element of care provision to pwALS and therefore guides decisions surrounding caregiving. On this understanding, those caregivers that succeed in holding the balance can provide care at home until death. The balance is heavily influenced by contextual factors of caregiving, for example relating to personal characteristics of the caregiver, or activities of caregiving where the goal is to ensure the quality of life of the pwALS. As there is a heterogeneity of speed and subtype of progression of ALS, our work accounts for multiple caregiving trajectories.

EDUCATIONAL VIDEO AS EFFECTIVE COMMUNICATION ON FORMAL AND INFORMAL CAREGIVER TO ELDERLY : A DESCRIPTIVE STUDY

Presbycusis is a progressive hearing loss which occurs at the age of 65. Communication difficulties caused by these problems are usually not understood or understood by people with normal hearing functions. Therefore, the understanding of these problems must be improved so that there is no gap between people with normal hearing and people with low hearing. The research method used is a quantitative descriptive research design carried out in a number of elderly care foundations. The data we share is in the form of pre-test and post-test questionnaires to elderly caregivers with hearing loss in order to evaluate the caregiver's understanding of the educational video. There was an increase in the understanding of the caregivers about how to communicate effectively based on the comparison of the scores from the pre-test and post-test final scores carried out before and after the education was given. Providing education to caregivers with educational video media provides effective results in increasing caregiver knowledge in this field. The formal caregiver group has better results than the informal caregiver group at 77.7% on the pre-test by formal caregiver and an assessment of 65% on the pre-test by informal caregiver. In the post-test assessment, the formal caregiver got a score of 87.7% and for the informal caregiver it was 90%. There is an increase in the post-test scores of the two caregiver groups after providing education through video media.

3D Virtual Reality Volumetric Imaging Review in Cancer Patients’ Understanding and Education of their Disease and Treatment

Cancer patients often struggle to understand their own disease, symptoms, therapy and treatment-related toxicities with current educational methods. Virtual reality (VR) has the potential to intuitively convey abstract, complex information. Patients' review and interaction of their own imaging in 3D may improve comprehension. This study aimed to assess the impact of using VR with cancer patients and their caregivers.In a single arm prospectively accrued mixed-method study during clinical visits in radiation oncology, 38 cancer patients and caregivers were shown their own 2D planer medical imaging on a computer screen followed by a 3D VR volumetric review of diagnostic imaging and radiation targets. Participants completed pre- and post-VR Likert scale questionnaires and interviews. Survey analysis utilized Wilcoxon signed-rank test. Interview data was analyzed qualitatively.Patient ages ranged from 11-95 years old with a median of 5 months from diagnosis to VR. Participants typically noted poor comprehension using standard educational tools in clinical visits. 2D imaging review was reported as challenging to interpret, confusing and nonintuitive. Quantitatively, patient and caregiver understanding of their own disease/tumor improved significantly from pre-VR (mean 5.6) to post-VR (mean 9.2; P < 0.0001; 0 = none, 10 = full). VR was rated the top educational tool by 83% of participants over all other educational strategies with 97% preferring VR over a 2D-computer screen in imaging review. In a head-to-head comparison, VR led to a higher level of understanding over 2D-imaging in every survey domain including tumor, symptoms, radiation target, treatment-related symptoms and therapy rationale (P < 0.0001). VR was also superior to 2D imaging review in decreasing anxiety, increasing engagement and providing higher satisfaction (P < 0.0001). Participants rated the importance of the VR experience with a mean value of 9.1 (0 = none, 10 = full). VR was recommended by 97% of participants to become standard of care. Qualitatively, participants noted VR as simple, obvious, informative and an easier method to understand their disease and treatment. VR provided additional comprehension and improved patient engagement with treatment and their providers. VR positively impacted attitudes in behavioral change towards improved adherence. Patients reported the value of VR in being able to understand what was transpiring within their own bodies.Current educational strategies for cancer patients need improvement. In this prospective study, 3D VR imaging review was shown to be more effective in conveying and contextualizing complex information regarding tumor anatomical spatial relationships by substantially improving understanding over currently utilized methods. VR was patients' most preferred and top-rated educational tool. These findings warrant evaluation of VR as a next generation educational tool in cancer patient consultations.

Experiences of Family Members in Caring of Stroke Patients: A Case Study in the Border Provinces of the Upper Northeast of Thailand

BACKGROUND: Stroke patients require continued care, which makes stroke family caregivers unlikely to anticipate the end of home health-care service. AIM: The objectives of this study aimed, therefore, to seek understanding of stroke family caregivers in relation to caring experience, problems and barriers, and needs of family caregivers in the context of border provinces of the upper northeast of Thailand. METHODS: The current study was based on the phenomenological approach. The study samples included 16 informants. Data collection, conducted between February and August 2020, was performed using in-depth interviews. The collected data then were analyzed using the van Manen’s approach. RESULTS: Experiences of the stroke family caregivers were reflected and fell in van Manen’s 4 points under 12 thematic categories: (1) Lived body including lack of knowledge, fatigue, and sense of obligation; (2) lived time including paying gratitude, uncertainty, and paying retribution; (3) lived space including just long distance, being isolated in the wide world and living in a remote area; and (4) lived relation including blood thicker than water, community network, and needs from health-care services. CONCLUSION: The findings may be exploited to develop health service preparedness for health outcome promotion for stroke patients and stroke family caregivers.