The convergence of prevalence, cost, symptom experience, community setting, and informal caregivi... more The convergence of prevalence, cost, symptom experience, community setting, and informal caregiving in heart failure (HF) has profound implications for outpatient palliative care. The majority of HF patients depend on informal caregiver's assistance. Dyadic (patients and caregiver) characteristics can complicate this assistance. Yet relatively little is known concerning dyadic characteristics' impact on self-care. HF self-care involves routine, daily treatment adherence and symptom monitoring (self-care maintenance), and symptom response (self-care management). Describe the dyadic characteristics of mood and perception of the relationship in HF patients and caregivers, then explore the relationship of the characteristics with self-care. Prospective, cross sectional study of hospitalized HF patients in mixed dyads (spousal/adult child/relative) analyzed using Actor-Partner Interdependence Model (APIM) techniques. Mood was measured by the Brief Symptom Inventory and Patient He...
Comorbidity is associated with decreased confidence or self-efficacy to perform self-care in hear... more Comorbidity is associated with decreased confidence or self-efficacy to perform self-care in heart failure patients which, in turn, impairs self-care behaviors. Comorbidity is also associated with increased hospitalization rates and poorer quality of life. Yet the manner in which comorbidity and self-efficacy interact to influence self-care, hospitalization, and quality of life remains unclear. The purpose of this study was to test an explanatory model. The research questions were (1) What is the contribution of comorbidity to heart failure self-care behaviors and outcomes (i.e. hospitalization, quality of life)? and (2) Is comorbidity a moderator of the relationship between self-efficacy and heart failure self-care behaviors? This was an analysis of an existing dataset of 628 symptomatic, older (mean age=73, standard deviation (SD)=11) male (58%) Italian heart failure patients using structural equation modeling and simple slope analysis. Higher levels of self-care maintenance were ...
Heart failure patients, along with their informal caregivers are increasingly enrolling in hospic... more Heart failure patients, along with their informal caregivers are increasingly enrolling in hospice care. Caregiver satisfaction with hospice care is a key quality indicator. The role that diagnosis plays in shaping satisfaction is unclear. Our aim was to identify unique correlates of caregiver satisfaction in heart failure and cancer caregivers and explore whether the identified correlates differ between the two diagnosis groups. This was a retrospective cohort study of national data collected in 2011 by the National Hospice and Palliative Care Organization using the 61-item Family Evaluation of Hospice Care survey. We used complete Family Evaluation of Hospice Care responses of adult heart failure (n = 7324) and cancer (n = 23,871) caregivers. Multiple logistic regression was used to examine the relationship between possible correlates and caregiver satisfaction. Correlates examined included caregiver and patient demographics, patient clinical characteristics, and hospice characteristics. Caregiver-reported patient dyspnea was associated with global and symptom management satisfaction in the heart failure cohort, whereas caregiver race was associated with global and symptom management satisfaction in the cancer cohort. Nursing home placement was associated with lower satisfaction odds in both cancer and heart failure cohorts, but heart failure patients were twice as likely as cancer patients to receive care in a nursing home. This study generated hypotheses about unique factors related to caregiver satisfaction among two diagnosis cohorts that require further study, particularly the impact of race on satisfaction in the cancer cohort and the management of dyspnea in heart failure hospice patients.
Background: Half of heart failure patients will die within five years of diagnosis, making them a... more Background: Half of heart failure patients will die within five years of diagnosis, making them an ideal population for hospice to reach. Yet hospice originated in oncology, and problems have been noted with the enrollment of heart failure patients. Whether caregiver satisfaction, a key quality measure in hospice, differs between heart failure and cancer caregivers is unknown. Objective: We aimed to determine whether diagnosis makes a difference in satisfaction with hospice care in matched cohorts of heart failure caregivers and cancer caregivers. Methods: This was a national cohort study, using caregiver responses to the Family Evaluation of Hospice Care (FEHC) survey. Heart failure and cancer caregivers were matched via propensity scoring. The relationship between diagnosis and caregiver satisfaction was examined across the domains of symptom management, emotional support, caregiver teaching, coordination of care, and global satisfaction, both before and after matching via logistic regression. Results: One-to-one matching with calipers yielded 7730 matched pairs out of an original sample of 8175 heart failure caregivers and 24,972 cancer caregivers. Significant differences were found in caregiver teaching, emotional support, coordination of care, and global satisfaction prior to matching, but the effect sizes were small. All differences disappeared after matching. High rates of dissatisfaction with caregiver teaching (42%) and emotional support (30%) were found in both cohorts. Conclusions: The diagnosis of heart failure, in and of itself, does not appear to make a difference in informal caregiver satisfaction with hospice care. Hospice provides high-quality care for patients, but improvements are needed in caring for the caregiver.
H eart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities... more H eart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age. 1 Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2,3 Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities.
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, Jan 14, 2014
Caregivers play an important role in contributing to heart failure (HF) patients' self-care b... more Caregivers play an important role in contributing to heart failure (HF) patients' self-care but no prior studies have examined the caregivers' contributions to HF patients' self-care and no prior studies have examined potential determinants of the caregivers' contribution to HF patients' self-care. The purpose of this study was to describe the caregivers' contribution to HF patients' self-care and identify its determinants. The study design involved a secondary analysis of cross-sectional data. Caregivers' contributions were measured with the Caregiver's Contribution to Self-care of HF Index (CC-SCHFI) which measures the caregiver's contribution to self-care maintenance and management and caregiver confidence in contributing to HF patient's self-care. Potential determinants were measured using a socio-demographic questionnaire completed by caregivers and patients, and patient clinical data was obtained from the medical record. Data from 51...
Negative values of incongruence indicate that patient reported greater contributions to care than... more Negative values of incongruence indicate that patient reported greater contributions to care than their caregiver; positive values indicate that caregivers report greater contributions to care than the patients.
Treatment of heart failure (HF) is particularly complex in the presence of comorbidities. We soug... more Treatment of heart failure (HF) is particularly complex in the presence of comorbidities. We sought to identify and associate comorbidity profiles with inpatient outcomes during HF hospitalizations.
Background: Heart failure is a burdensome clinical syndrome, and patients and their caregivers ar... more Background: Heart failure is a burdensome clinical syndrome, and patients and their caregivers are responsible for the vast majority of heart failure care.
Background. Everything known about the roles, relationships, and repercussions of comorbidity in ... more Background. Everything known about the roles, relationships, and repercussions of comorbidity in cardiovascular disease is shaped by how comorbidity is currently measured. Objectives. To critically examine how comorbidity is measured in randomized controlled trials or clinical trials and prospective observational studies in acute myocardial infarction (AMI), heart failure (HF), or stroke. Design. Systematic review of studies of hospitalized adults from MEDLINE CINAHL, PsychINFO, and ISI Web of Science Social Science databases. At least two reviewers screened and extracted all data. Results. From 1432 reviewed abstracts, 26 studies were included (AMI = 8, HF = 11, stroke = 7). Five studies used an instrument to measure comorbidity while the remaining used the presence or absence of an unsubstantiated list of individual diseases. Comorbidity data were obtained from 1-4 different sources with 35% of studies not reporting the source. A year-by-year analysis showed no changes in measurement. Conclusions. The measurement of comorbidity remains limited to a list of conditions without stated rationale or standards increasing the likelihood that the true impact is underestimated.
Background. Chronic medical conditions often occur in combination. Understanding underlying mecha... more Background. Chronic medical conditions often occur in combination. Understanding underlying mechanisms causing diseases and their interactions may make it possible to address multiple complex conditions with single or consolidated treatment approaches and improve patients' health outcomes while reducing costs. Objectives. We present a synthesis of the current interprofessional discourse on the issues surrounding comorbidities. Methods. A targeted review of the literature was conducted using published editorials, commentaries, and review articles. Results. Errors in conceptualization and measurement plague our current understanding of comorbidities. Two potential paths to generating knowledge involve the use of etiological or epidemiological approach. An etiological approach investigates the risk factors and underlying mechanisms potentially leading to consolidation of diagnosis and treatments. Because of the rudimentary stage of knowledge development in this area, this approach will require time and significant research investments. In contrast, the epidemiological approach relies on statistical identification of disease entities that cooccur beyond random chance; this approach carries an accompanying risk of diagnostic and treatment proliferation. Discussion. The concept of comorbidity, its nature, and measurement is in need of meaningful debate by the scientific and clinical communities. Recommendations in the domains of conceptualization, research, and measurement are discussed.
To test the validity and reliability of the Spiritual Needs Inventory (SNI) in measuring the spir... more To test the validity and reliability of the Spiritual Needs Inventory (SNI) in measuring the spiritual needs of informal caregivers of patients with cancer in hospice home care. A subanalysis of a longitudinal, randomized hospice clinical trial. Two hospices in the southwestern United States. 410 informal caregivers of patients with cancer in hospice home care. To test the hypotheses, Pearson and Spearman correlations, principal factor analysis with oblique rotation, and coefficient alpha were conducted. Spiritual needs, depression, social support. The SNI showed a small but significant positive correlation with the social support (p = 0.003). A three-factor solution of the SNI accounted for about 55% of the variability. The first factor captured a traditional religious measure, with the original patient-reported subscales of inspiration, spiritual activities, and religion collapsing into this one factor. The second and third factors were similar to the original patient study. Cronbach alpha for the total scale was 0.88. The factor alphas ranged from 0.68-0.89. The current study provides early evidence for the validity and reliability of the SNI in informal caregivers of patients with cancer in hospice home care. Additional testing in other populations is recommended. Use of the SNI with hospice caregivers could aid nurses in the identification of spiritual needs, enabling the development of plans of individualized, high-quality care.
To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide ev... more To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide evidence for the validity and reliability of the model for use in practice and research. Nonexperimental and cross-sectional using baseline data collected within 24-72 hours of admission to hospice. Two hospices in the southeastern United States. 403 hospice homecare patients; 56% were men and 97% were Caucasian with a mean age of 77.7 years. Confirmatory factor analyses using structural equation modeling with AMOS statistical software. Clinical status; physiologic, psychological, and spiritual variables; and quality of life (QOL). A three-factor model with QOL as an outcome variable showed that 67% of the variability in QOL is explained by the patient's symptom and spiritual experiences. As symptoms and associated severity and distress increase, the patient's QOL decreases. As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion), QOL also increases. The model supports caring for the physical and metaphysical dimensions of the patient's life. It also highlights a need for holistic care inclusive of physical, emotional, and spiritual domains.
The convergence of prevalence, cost, symptom experience, community setting, and informal caregivi... more The convergence of prevalence, cost, symptom experience, community setting, and informal caregiving in heart failure (HF) has profound implications for outpatient palliative care. The majority of HF patients depend on informal caregiver's assistance. Dyadic (patients and caregiver) characteristics can complicate this assistance. Yet relatively little is known concerning dyadic characteristics' impact on self-care. HF self-care involves routine, daily treatment adherence and symptom monitoring (self-care maintenance), and symptom response (self-care management). Describe the dyadic characteristics of mood and perception of the relationship in HF patients and caregivers, then explore the relationship of the characteristics with self-care. Prospective, cross sectional study of hospitalized HF patients in mixed dyads (spousal/adult child/relative) analyzed using Actor-Partner Interdependence Model (APIM) techniques. Mood was measured by the Brief Symptom Inventory and Patient He...
Comorbidity is associated with decreased confidence or self-efficacy to perform self-care in hear... more Comorbidity is associated with decreased confidence or self-efficacy to perform self-care in heart failure patients which, in turn, impairs self-care behaviors. Comorbidity is also associated with increased hospitalization rates and poorer quality of life. Yet the manner in which comorbidity and self-efficacy interact to influence self-care, hospitalization, and quality of life remains unclear. The purpose of this study was to test an explanatory model. The research questions were (1) What is the contribution of comorbidity to heart failure self-care behaviors and outcomes (i.e. hospitalization, quality of life)? and (2) Is comorbidity a moderator of the relationship between self-efficacy and heart failure self-care behaviors? This was an analysis of an existing dataset of 628 symptomatic, older (mean age=73, standard deviation (SD)=11) male (58%) Italian heart failure patients using structural equation modeling and simple slope analysis. Higher levels of self-care maintenance were ...
Heart failure patients, along with their informal caregivers are increasingly enrolling in hospic... more Heart failure patients, along with their informal caregivers are increasingly enrolling in hospice care. Caregiver satisfaction with hospice care is a key quality indicator. The role that diagnosis plays in shaping satisfaction is unclear. Our aim was to identify unique correlates of caregiver satisfaction in heart failure and cancer caregivers and explore whether the identified correlates differ between the two diagnosis groups. This was a retrospective cohort study of national data collected in 2011 by the National Hospice and Palliative Care Organization using the 61-item Family Evaluation of Hospice Care survey. We used complete Family Evaluation of Hospice Care responses of adult heart failure (n = 7324) and cancer (n = 23,871) caregivers. Multiple logistic regression was used to examine the relationship between possible correlates and caregiver satisfaction. Correlates examined included caregiver and patient demographics, patient clinical characteristics, and hospice characteristics. Caregiver-reported patient dyspnea was associated with global and symptom management satisfaction in the heart failure cohort, whereas caregiver race was associated with global and symptom management satisfaction in the cancer cohort. Nursing home placement was associated with lower satisfaction odds in both cancer and heart failure cohorts, but heart failure patients were twice as likely as cancer patients to receive care in a nursing home. This study generated hypotheses about unique factors related to caregiver satisfaction among two diagnosis cohorts that require further study, particularly the impact of race on satisfaction in the cancer cohort and the management of dyspnea in heart failure hospice patients.
Background: Half of heart failure patients will die within five years of diagnosis, making them a... more Background: Half of heart failure patients will die within five years of diagnosis, making them an ideal population for hospice to reach. Yet hospice originated in oncology, and problems have been noted with the enrollment of heart failure patients. Whether caregiver satisfaction, a key quality measure in hospice, differs between heart failure and cancer caregivers is unknown. Objective: We aimed to determine whether diagnosis makes a difference in satisfaction with hospice care in matched cohorts of heart failure caregivers and cancer caregivers. Methods: This was a national cohort study, using caregiver responses to the Family Evaluation of Hospice Care (FEHC) survey. Heart failure and cancer caregivers were matched via propensity scoring. The relationship between diagnosis and caregiver satisfaction was examined across the domains of symptom management, emotional support, caregiver teaching, coordination of care, and global satisfaction, both before and after matching via logistic regression. Results: One-to-one matching with calipers yielded 7730 matched pairs out of an original sample of 8175 heart failure caregivers and 24,972 cancer caregivers. Significant differences were found in caregiver teaching, emotional support, coordination of care, and global satisfaction prior to matching, but the effect sizes were small. All differences disappeared after matching. High rates of dissatisfaction with caregiver teaching (42%) and emotional support (30%) were found in both cohorts. Conclusions: The diagnosis of heart failure, in and of itself, does not appear to make a difference in informal caregiver satisfaction with hospice care. Hospice provides high-quality care for patients, but improvements are needed in caring for the caregiver.
H eart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities... more H eart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age. 1 Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2,3 Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities.
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, Jan 14, 2014
Caregivers play an important role in contributing to heart failure (HF) patients' self-care b... more Caregivers play an important role in contributing to heart failure (HF) patients' self-care but no prior studies have examined the caregivers' contributions to HF patients' self-care and no prior studies have examined potential determinants of the caregivers' contribution to HF patients' self-care. The purpose of this study was to describe the caregivers' contribution to HF patients' self-care and identify its determinants. The study design involved a secondary analysis of cross-sectional data. Caregivers' contributions were measured with the Caregiver's Contribution to Self-care of HF Index (CC-SCHFI) which measures the caregiver's contribution to self-care maintenance and management and caregiver confidence in contributing to HF patient's self-care. Potential determinants were measured using a socio-demographic questionnaire completed by caregivers and patients, and patient clinical data was obtained from the medical record. Data from 51...
Negative values of incongruence indicate that patient reported greater contributions to care than... more Negative values of incongruence indicate that patient reported greater contributions to care than their caregiver; positive values indicate that caregivers report greater contributions to care than the patients.
Treatment of heart failure (HF) is particularly complex in the presence of comorbidities. We soug... more Treatment of heart failure (HF) is particularly complex in the presence of comorbidities. We sought to identify and associate comorbidity profiles with inpatient outcomes during HF hospitalizations.
Background: Heart failure is a burdensome clinical syndrome, and patients and their caregivers ar... more Background: Heart failure is a burdensome clinical syndrome, and patients and their caregivers are responsible for the vast majority of heart failure care.
Background. Everything known about the roles, relationships, and repercussions of comorbidity in ... more Background. Everything known about the roles, relationships, and repercussions of comorbidity in cardiovascular disease is shaped by how comorbidity is currently measured. Objectives. To critically examine how comorbidity is measured in randomized controlled trials or clinical trials and prospective observational studies in acute myocardial infarction (AMI), heart failure (HF), or stroke. Design. Systematic review of studies of hospitalized adults from MEDLINE CINAHL, PsychINFO, and ISI Web of Science Social Science databases. At least two reviewers screened and extracted all data. Results. From 1432 reviewed abstracts, 26 studies were included (AMI = 8, HF = 11, stroke = 7). Five studies used an instrument to measure comorbidity while the remaining used the presence or absence of an unsubstantiated list of individual diseases. Comorbidity data were obtained from 1-4 different sources with 35% of studies not reporting the source. A year-by-year analysis showed no changes in measurement. Conclusions. The measurement of comorbidity remains limited to a list of conditions without stated rationale or standards increasing the likelihood that the true impact is underestimated.
Background. Chronic medical conditions often occur in combination. Understanding underlying mecha... more Background. Chronic medical conditions often occur in combination. Understanding underlying mechanisms causing diseases and their interactions may make it possible to address multiple complex conditions with single or consolidated treatment approaches and improve patients' health outcomes while reducing costs. Objectives. We present a synthesis of the current interprofessional discourse on the issues surrounding comorbidities. Methods. A targeted review of the literature was conducted using published editorials, commentaries, and review articles. Results. Errors in conceptualization and measurement plague our current understanding of comorbidities. Two potential paths to generating knowledge involve the use of etiological or epidemiological approach. An etiological approach investigates the risk factors and underlying mechanisms potentially leading to consolidation of diagnosis and treatments. Because of the rudimentary stage of knowledge development in this area, this approach will require time and significant research investments. In contrast, the epidemiological approach relies on statistical identification of disease entities that cooccur beyond random chance; this approach carries an accompanying risk of diagnostic and treatment proliferation. Discussion. The concept of comorbidity, its nature, and measurement is in need of meaningful debate by the scientific and clinical communities. Recommendations in the domains of conceptualization, research, and measurement are discussed.
To test the validity and reliability of the Spiritual Needs Inventory (SNI) in measuring the spir... more To test the validity and reliability of the Spiritual Needs Inventory (SNI) in measuring the spiritual needs of informal caregivers of patients with cancer in hospice home care. A subanalysis of a longitudinal, randomized hospice clinical trial. Two hospices in the southwestern United States. 410 informal caregivers of patients with cancer in hospice home care. To test the hypotheses, Pearson and Spearman correlations, principal factor analysis with oblique rotation, and coefficient alpha were conducted. Spiritual needs, depression, social support. The SNI showed a small but significant positive correlation with the social support (p = 0.003). A three-factor solution of the SNI accounted for about 55% of the variability. The first factor captured a traditional religious measure, with the original patient-reported subscales of inspiration, spiritual activities, and religion collapsing into this one factor. The second and third factors were similar to the original patient study. Cronbach alpha for the total scale was 0.88. The factor alphas ranged from 0.68-0.89. The current study provides early evidence for the validity and reliability of the SNI in informal caregivers of patients with cancer in hospice home care. Additional testing in other populations is recommended. Use of the SNI with hospice caregivers could aid nurses in the identification of spiritual needs, enabling the development of plans of individualized, high-quality care.
To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide ev... more To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide evidence for the validity and reliability of the model for use in practice and research. Nonexperimental and cross-sectional using baseline data collected within 24-72 hours of admission to hospice. Two hospices in the southeastern United States. 403 hospice homecare patients; 56% were men and 97% were Caucasian with a mean age of 77.7 years. Confirmatory factor analyses using structural equation modeling with AMOS statistical software. Clinical status; physiologic, psychological, and spiritual variables; and quality of life (QOL). A three-factor model with QOL as an outcome variable showed that 67% of the variability in QOL is explained by the patient's symptom and spiritual experiences. As symptoms and associated severity and distress increase, the patient's QOL decreases. As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion), QOL also increases. The model supports caring for the physical and metaphysical dimensions of the patient's life. It also highlights a need for holistic care inclusive of physical, emotional, and spiritual domains.
Uploads
Papers by Harleah Buck