Peterson Kendra, Hahn Howard, Lee Amber J, Madison Catherine A, Atri Alireza
Ray Dolby Brain Health Center; California Pacific Medical Center, a Sutter Health Affiliate, San Francisco, CA, USA.
California Pacific Medical Center Research Institute, San Francisco, CA, USA.
BMC Geriatr. 2016 Sep 23;16(1):164. doi: 10.1186/s12877-016-0338-7.
Most patients with dementia or cognitive impairment receive care from family members, often untrained for this challenging role. Caregivers may not access publicly available caregiving information, and caregiver education programs are not widely implemented clinically. Prior large surveys yielded broad quantitative understanding of caregiver information needs, but do not illuminate the in-depth, rich, and nuanced caregiver perspectives that can be gleaned using qualitative methodology.
We aimed to understand perspectives about information sources, barriers and preferences, through semi-structured interviews with 27 caregivers. Content analysis identified important themes.
We interviewed 19 women, 8 men; mean age 58.5 years; most adult children (15) or spouses (8) of the care recipient. Dementia symptoms often developed insidiously, with delayed disease acknowledgement and caregiver self-identification. While memory loss was common, behavioral symptoms were most troublesome, often initially unrecognized as disease indicators. Emerging themes: 1.) Barriers to seeking information often result from knowledge gaps, rather than reluctance to assume the caregiver role; 2.) Most caregivers currently receive insufficient information. Caregivers are open to many information sources, settings, and technologies, including referrals to other healthcare professionals, print material, and community and internet resources, but expect the primary care provider (PCP) to recommend, endorse, and guide them to specific sources.
These findings replicated and expanded on results from previous quantitative surveys and, importantly, revealed a previously unrecognized essential factor: despite receiving insufficient information, caregivers place critical value on their relationship with care recipient PCPs to receive recommendations, guidance and endorsement to sources of caregiving information. Implications include: 1.) Greater public education is needed to help caregivers identify and describe diverse cognitive, functional and behavioral symptoms that lead to dementia, and recognize the benefits of early detection in accessing information regarding multi-modality management and care; 2.) Improved methods are needed for PCPs to detect and manage cognitive and behavioral changes, as well as mechanisms that facilitate the busy PCP, either directly or via referral, to provide caregiver information, education, support, and services. The critical relationship between caregivers and PCPs should not be circumvented but should be facilitated to provide more effective guidance regarding dementia caregiver needs.
大多数痴呆或认知障碍患者由家庭成员照料,而这些家庭成员往往未接受过应对这一具有挑战性角色的培训。照料者可能无法获取公开可用的照料信息,且照料者教育项目在临床上并未广泛实施。此前的大型调查对照料者的信息需求有了广泛的定量理解,但未能阐明使用定性方法所能收集到的深入、丰富且细致入微的照料者观点。
我们旨在通过对27名照料者进行半结构化访谈,了解他们对信息来源、障碍和偏好的看法。内容分析确定了重要主题。
我们访谈了19名女性和8名男性;平均年龄58.5岁;大多数是受照料者的成年子女(15人)或配偶(8人)。痴呆症状通常隐匿出现,疾病确认和照料者自我认定均延迟。虽然记忆丧失很常见,但行为症状最麻烦,最初往往未被视为疾病指标。新出现的主题如下:1.)寻求信息的障碍往往源于知识差距,而非不愿承担照料者角色;2.)目前大多数照料者获得的信息不足。照料者对许多信息来源、场所和技术持开放态度,包括转介给其他医疗保健专业人员、印刷材料以及社区和互联网资源,但期望初级保健提供者(PCP)推荐、认可并引导他们获取特定信息来源。
这些发现重复并扩展了先前定量调查的结果,重要的是,揭示了一个此前未被认识到的关键因素:尽管获得的信息不足,但照料者高度重视他们与受照料者的初级保健提供者的关系,以便获得关于照料信息来源的建议、指导和认可。其影响包括:1.)需要加强公众教育,以帮助照料者识别和描述导致痴呆的各种认知、功能和行为症状,并认识到早期检测在获取多模式管理和照料信息方面的益处;2.)初级保健提供者需要改进检测和管理认知及行为变化的方法,以及促进忙碌的初级保健提供者直接或通过转介提供照料者信息、教育、支持和服务的机制。不应规避照料者与初级保健提供者之间的关键关系,而应加以促进,以便就痴呆照料者的需求提供更有效的指导。