Assessing Caregiver for Team Interventions (ACT): A New Paradigm for Comprehensive Hospice Quality Care Page: 3
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Demiris et al. Page 3
caregiver of a dying relative at home.23 Kinsella and colleagues23 categorized caregiver
burden into an objective form, represented by tangible costs, physical care demands, and
disruptions to daily routines, and a subjective form represented by the caregiver's appraisal of
Z the impact of caring, the emotions aroused by caregiving, and the coping resources. In this
context, Kinsella et a123 identified factors that affect the caregiving experience: personality,
stressor appraisal, use of coping strategies, the availability and adequacy of social support,
family functioning, and competing commitments.
The degree of anxiety occurring as a consequence of caregiving is counterbalanced by some
degree of positive gains from the experience along with the degree of support and information
gained from the hospice staff.24 In situations where the stress outweighs personal resources
and external coping, general health and well-being deteriorates, social participation is inhibited
c and there are inevitable psychological complications.23,25 Due to this stress response, the use
). of an anxiety appraisal and coping model helps to understand the process of any intervention
aimed at reducing anxiety through the provision of support and information. The most
comprehensive model of stress and coping indicating the mediating factors in the process of
caregiving was developed by Pearlin et al,26 which was further developed and modified by
Meyers and Gray.27
We are proposing an approach labeled Assessing Caregivers for Team Interventions (ACT)
that is based on the ongoing assessment of the background context, primary, secondary, and
Zintrapsychic stressors as well as outcomes of the caregiving experience and subsequently, the
I design and delivery of appropriate interventions to be delivered by the hospice team (ensuring
a holistic approach to addressing the multifaceted challenges of the caregiving experience).
Assessing caregivers for team interventions can therefore act as one of the mediators that can
Affect the overall caregiver experience and improve outcomes such as satisfaction with hospice
=r care, reduce anxiety, and improve overall quality of care (see Figure 1).
Assessing caregivers' background, primary, secondary, and intrapsychic stressors and tailoring
a team intervention enable hospice providers to not only gain insight into the caregiving
experience but to also address any stressors and provide the tools that can mediate stress
Responses with appropriate support and information. The background context should already
be part of the patient's chart. The assessment of primary, secondary, intrapsychic stressors,
and outcomes can rely on standardized instruments as well as interactions and observations by
hospice providers. The hospice team can then review findings during the IDT meetings and
determine a plan of action based on identified needs and challenges and areas of expertise of
the participating members.
To increase the efficiency of ACT as a model of inclusive and holistic care, it is appropriate
Z for 1 member of the hospice team to act as the caregiver advocate who summarizes the findings
I of the ongoing assessment and highlights areas that need to be addressed by the team. This
-3 member can also ensure that caregivers are informed and have access to appropriate resources,
and as a caregiver advocate explore ways to increase communication between the family
r caregiver and the IDT team and solicit caregiver's feedback in the decision making process.
Assessing caregivers for team interventions is a tool to enable the implementation of the overall
-- theoretical premise of hospice care that dictates treating patients and their family caregiver as
cmDelivering Team Interventions
-0 The IDT interventions based on the caregiver assessment can be aiming to reduce the actual
caregiving tasks and/or provide support and enhance caregivers' coping skills and education.
Such empowering interventions designed by the hospice team can draw from the theoretical
Framework of the prepared family caregiver model,26 which indicates that training caregivers
Am JHosp Palliat Care. Author manuscript; available in PMC 2009 April 7.
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Demiris, George; Oliver, Debra Parker & Wittenberg-Lyles, Elaine. Assessing Caregiver for Team Interventions (ACT): A New Paradigm for Comprehensive Hospice Quality Care, article, 2009; [Thousand Oaks, California]. (digital.library.unt.edu/ark:/67531/metadc275802/m1/3/: accessed January 18, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT College of Arts and Sciences.