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Elective abdominal aortic aneurysm (AAA) repair for patients with a diagnosis of cancer has remained controversial. In the present study, we evaluated the in-hospital outcomes for patients who had undergone AAA repair in the setting of a cancer diagnosis. Inpatients (2008-2018) who had undergone elective AAA repair were selected from the Cerner Health Facts database using International Classification of Diseases, ninth and tenth revision, procedure codes. We used χ2 analysis and logistic regression models to evaluate the association of patient characteristics with the medical and vascular outcomes. A total of 8663 patients who had undergone AAA repair were identified (270 with a cancer diagnosis and 8393 without a cancer diagnosis). No significant demographic differences were found between the two groups, except that more patients with a cancer diagnosis had undergone endovascular aneurysm repair (EVAR) than open aneurysm repair (88.2% vs 82.1%; P =.01). Male reproductive organ (24.8%) and lung (24.4%) cancer were the most common cancer diagnoses in the cohort. The unadjusted analysis revealed that patients with a cancer diagnosis were more likely to require remedial EVAR (relative risk, 3.47; 95% confidence interval [CI], 1.18-10.2) or reoperation for bleeding, infection, or thrombosis (relative risk, 1.59; 95% CI, 1.09-2.32). Multivariable analysis demonstrated that, overall, patients with a cancer diagnosis were more likely to require a prolonged length of stay (odds ratio [OR], 2.2; 95% CI, 1.5-3.3) and to have developed respiratory failure (OR, 2.1; 95% CI, 1.3-3.4) or infection (OR, 1.7; 95% CI, 1.2-2.4). Similar point estimates were found for men with and without a cancer diagnosis. However, women with a cancer diagnosis had a greater odds of a prolonged length of stay compared with women without a cancer diagnosis (OR, 2.6; 95% CI, 1.2-5.6). EVAR in the presence of a cancer diagnosis was also significantly associated with poor outcomes. Elective AAA repair for patients with a cancer diagnosis was associated with a prolonged length of stay and the development of infection, respiratory failure, and vascular-specific complications during the inpatient hospitalization. Given that differences in outcomes stratified by gender and treatment modality have been shown for patients with a cancer diagnosis, careful patient selection is important and reinforces the finding that cancer exerts negative systemic postoperative effects even when treated or quiescent. [ABSTRACT FROM AUTHOR]

A low albumin level has been associated with poor outcome, including death, in surgical patients. The mechanistic relationship, however, is more complex than simply nutritional. As studies are scant in the vascular population, we sought to examine the association of low albumin level with outcomes in patients undergoing open and endovascular lower extremity procedures for peripheral artery disease. Patients with peripheral artery disease undergoing lower extremity procedures (2008-2015) were selected from Cerner Health Facts database (Cerner Corporation, Kansas City, Mo) using International Classification of Diseases, Ninth Revision diagnosis and procedure codes. Age, sex, disease severity, and other comorbidities were captured. Outcomes were identified using codes and encounter data. A χ 2analysis and multivariable logistic regression were performed. There were 6170 patients evaluated; 4562 (74%) underwent endovascular procedures and 1608 (26%) underwent open surgery. Low albumin level (<3.5 g/dL) was associated with age ≥80 years (23.1% vs 16.3% normal; P <.0001), black race (21% vs 11.6% normal; P <.0001), tissue loss (38% vs 16.4% normal; P <.0001), and higher Charlson index (mean, 3.1 vs 2.2 in the normal group; P <.0001). Low albumin level was also associated with longer length of stay (4.9 vs 2.2 days normal; P <.0001), higher in-hospital mortality (1.9% vs 0.3% normal; P <.0001), and higher 30-day readmission (15% vs 12.7% normal; P =.02). Multivariable analysis demonstrated that low albumin level was strongly associated with in-hospital death (odds ratio [OR], 5.23; 95% confidence interval [CI], 2.00-13.70), infection (OR, 2.51; 95% CI, 1.96-3.22), renal failure (OR, 2.61; 95% CI, 1.79-3.79), and cardiac complications (OR, 2.59; 95% CI, 1.69-3.96). After multivariable adjustment, there was no association between albumin level and 30-day readmission. Low preoperative albumin levels are associated with in-hospital death, prolonged length of stay, and severe morbidity after open and endovascular lower extremity procedures. As the majority of lower extremity procedures are elective, serious consideration should be given to deferring elective procedures until albumin levels have been optimized. Because of the pleiotropic effects of albumin, including antiplatelet and inflammatory function, study of this complex relationship may offer insights into how best to integrate this novel biomarker into vascular surgery decision-making. [ABSTRACT FROM AUTHOR]

Peripheral artery disease (PAD) has been shown to affect health status and quality of life; however, the disability associated by specific anatomic level of disease is unknown. We evaluated patients presenting with claudication by anatomic level and used the Peripheral Artery Questionnaire (PAQ), a PAD-specific validated tool, to quantify patients' symptoms, function, treatment satisfaction, and quality of life. The Patient-centered Outcomes Related to Treatment Practices in peripheral Arterial disease: Investigating Trajectories (PORTRAIT) registry is a multicenter, international, prospective study of patients with PAD. Anatomic level of PAD was stratified as follows: aortoiliac only, femoral-popliteal only, infrapopliteal only, and multilevel disease. Health status information was collected at baseline and at 3, 6, and 12 months using the PAQ. Student t -test, χ 2 test, and linear mixed effects models were examined. Anatomic data were present in 623 (48.9%) of 1275 patients: 127 aortoiliac (20.4%), 221 femoral-popliteal (35.5%), 39 infrapopliteal (6.3%), and 236 multilevel disease (37.9%). Groups were similar by sex and race. Baseline PAQ summary scores differed between lesions, with multilevel disease having the lowest (poorest) estimated PAQ summary score (P =.014). Patients with aortoiliac disease were significantly younger, were more likely to be smokers, and presented with higher ankle-brachial index (all P <.05). Almost one-fourth of patients underwent an intervention by 3 months, 83% of which were endovascular. Repeated-measures analyses demonstrated a significant association between anatomic lesion and PAQ scores over time (P =.016), even after adjustment for age, sex, work status, ankle-brachial index, smoking, history of diabetes and chronic kidney disease, and country. Multilevel disease had the lowest adjusted average PAQ summary score over time (63.1; 95% confidence interval [CI], 60.8-65.5) and was significantly lower than aortoiliac (68.1; 95% CI, 64.8-71.4; P =.02) and femoral-popliteal (68.2; 95% CI, 65.8-70.6; P =.002) but not infrapopliteal (66.2; 95% CI, 60.5-72.0; P =.32). Overall, patients with claudication had similar health status on presentation by level of disease, yet patients with isolated aortoiliac disease fared significantly better over time with regard to quality of life and PAQ scores. Subset analysis demonstrated that patients undergoing interventions for aortoiliac disease and multilevel disease, which were primarily endovascular procedures, appeared to improve health status more over time compared with femoral-popliteal and infrapopliteal interventions. No significant benefits were found with intervention for femoral-popliteal disease or infrapopliteal disease compared with medical management. Treatment of aortoiliac and multilevel disease for claudication should be considered by clinicians as it may represent the greatest potential benefit for improving overall health status in patients with PAD. Further studies evaluating intervention compared with medical management alone are needed to further evaluate this finding. [ABSTRACT FROM AUTHOR]

Neutrophil-lymphocyte ratio (NLR) has been associated with inferior outcomes after lower extremity interventions. NLR has been associated with systemic inflammation and atherosclerotic burden. We examined NLR, severity of peripheral artery disease (PAD), and outcomes after endovascular or open surgical procedures. Inpatients undergoing lower extremity procedures (2008-2016) were selected from Cerner Health Facts database (Cerner Corporation, North Kansas City, Mo) using International Classification of Diseases, Ninth Revision procedure codes. Disease severity was grouped into claudication, rest pain, and tissue loss. Outcomes were identified using International Classification of Diseases, Ninth Revision codes. NLR was calculated preoperatively and postoperatively. A χ 2 analysis and multivariable logistic regression were performed. A receiver operating characteristic curve analysis was used to determine the cutoff for preoperative (low, <3.65; high, ≥3.65) and postoperative (low, <5.96; high, ≥5.96) NLR values. There were 3687 patients evaluated; 2183 (59%) underwent endovascular procedures and 1504 (41%) had open procedures. Compared with black patients, claudication was more frequent in white patients (81.7% vs 72.7%; P <.0001), and tissue loss was less common (12.9% vs 20.9%; P <.0001). NLR values were higher for patients with tissue loss than for patients with rest pain or claudication (4.89, 4.33, and 3.11, respectively; P <.0001). Open procedures were associated with higher postoperative NLR values than endovascular procedures (6.8 vs 5.2; P <.0001). Mean preoperative and postoperative NLR values were greater in patients with more severe PAD. Multivariable analysis demonstrated that preoperative high NLR was strongly associated with in-hospital death (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.68-17.07), cardiac complications (OR, 2.9; 95% CI, 1.57-5.40), amputation (OR, 2.5; 95% CI, 1.65-3.87), renal failure (OR, 1.9; 95% CI, 1.18-2.93), respiratory complications (OR, 1.7; 95% CI, 1.09-2.76), and prolonged length of stay (OR, 1.9; 95% CI, 1.89-3.71). Preoperative and postoperative NLR significantly increases with disease severity for PAD, providing further evidence of NLR as a biomarker of a patient's systemic inflammatory state. After adjustment for confounders, NLR still remained strongly associated with death and other adverse outcomes after intervention for PAD. Further study of the clinical association of NLR with other vascular disorders, such as symptomatic carotid stenosis and symptomatic and ruptured aortic aneurysmal disease, is planned to guide individualized treatment to prevent stroke or aneurysm rupture. [ABSTRACT FROM AUTHOR]

Context: There is a need for brief measurement instruments that do not cause burden to hospice caregivers. The Caregiver Quality of Life Index (CQLI) has been used in several studies, but assessment of its psychometric properties has been minimal. The CQLI-R (revised) instrument was found to have equivalent properties but also has had minimal testing in small samples.Objective: This study sought to evaluate the reliability and validity of the CQLI-R.Methods: Data were used from three hospice clinical trials. Reliability was assessed using test-retest and an item analysis. Construct validity was evaluated by comparing items to similar items within the same data set.Results: Test-rest and item analysis found moderate-to-good reliability. Construct validity found significance in comparison of CQLI-R items with those of similar instruments.Conclusions: The CQLI-R is an easy-to-use instrument to assess caregiver quality of life. Despite adequate reliability and construct validity, further evidence is needed to support content validity. [ABSTRACT FROM AUTHOR]

Objective The effect of postoperative hyperglycemia in patients undergoing open and endovascular procedures on the lower extremities has not been fully characterized with regard to associated admission diagnoses, hospital complications, mortality, and 30-day readmission. This study evaluated the relationship of postoperative hyperglycemia on outcomes after lower extremity vascular procedures for peripheral artery disease. Methods Patients with peripheral artery disease admitted for elective lower extremity procedures between September 2008 and March 2014 were selected from the Cerner Health Facts (Cerner Corporation, Kansas City, Mo) database using International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis and procedure codes. Using χ 2 analysis, we evaluated the relationship of postoperative hyperglycemia (>180 mg/dL) with sociodemographic characteristics, acute and chronic diagnoses, infections, hospital length of stay (LOS), and 30-day readmission. An adjusted multivariable logistic model was used to examine the association of postoperative hyperglycemia with infection and LOS. Results Of 3586 patients in the study, 2812 (78%) had optimal postoperative glucose control, and 774 (22%) had suboptimal glucose control (hyperglycemia). On average, patients with postoperative hyperglycemia experienced longer hospital stays (6.9 vs 5.1 days; P < .0001), higher Charlson Comorbidity Index scores (3.4 vs 2.5, P < .0001), higher rates of infection (23% vs 14%, P < .0001), more acute complications (ie, fluid and electrolyte disorders, acute renal failure, postoperative respiratory complications), and chronic problems (ie, anemia, chronic heart disease, chronic kidney disease, and diabetes) than patients with optimal glucose control. Overall 30-day readmission was 10.9% and was similar between the groups (10.9% for both; P = .93). Major amputations did not differ between groups ( P = .21). After adjusting for other risk factors using multivariable logistic regression, patients with hyperglycemia have 1.3-times the odds to have an infectious complication compared with those with optimal glucose control (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.06-1.69) and 1.7-times the odds to have a hospital LOS >10 days (OR, 1.69; 95% CI, 1.32-2.15). As well, patients with postoperative hyperglycemia have 8.4-times the odds of dying in the hospital (OR, 8.40; 95% CI, 3.95-17.9). Conclusions One in five patients undergoing vascular procedures had postoperative hyperglycemia. Postoperative hyperglycemia was associated with adverse events after lower extremity vascular procedures in patients with and without diabetes, including infection, increased hospital utilization, and mortality. No difference was found with respect to hospital readmission. Postprocedure glucose management may represent an important quality marker for improving outcomes after lower extremity vascular procedures. [ABSTRACT FROM AUTHOR]

Objective Cilostazol, an antiplatelet agent with vasodilating properties, has not been well evaluated in conjunction lower extremity revascularization (LER). We evaluated the association between cilostazol and limb salvage after endovascular or open surgery for LER. Methods Patients aged ≥65 years undergoing LER were identified from 2007 to 2008 Medicare Provider Analysis and Review and Carrier files using International Classification of Diseases-9 Edition-Clinical Modification and Current Procedural Terminology-4 codes. Covariates included demographics, comorbidities, and disease severity. Use of cilostazol was identified using National Drug Codes and Part D files. Outcomes were compared using χ 2 and Kaplan-Meier analyses and Cox regression. Results We identified 22,954 patients undergoing LER: 8128 (35.4%) with claudication, 3056 (13.3%) with rest pain, and 11,770 (51.3%) with ulceration/gangrene. Among them, 1999 patients (8.7%) used cilostazol before LER. More patients received endovascular (14,353) than open (8601) procedures. Cilostazol users had fewer amputations than nonusers at 30 days (7.8% vs 13.4%), 90 days (10.7% vs 18.0%), and 1 year (14.8% vs 24.0%; P < .0001 for all). Cox proportional hazards regression with adjustment for age, gender, race, comorbidities, type of procedure, and atherosclerosis severity showed noncilostazol users were more likely to undergo amputation ≤1 year after surgery (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.02-1.29; P = .02). Subgroup analyses using Cox proportional hazards models adjusted for age, gender, and comorbidities demonstrated significantly improved 1-year amputation-free survival for patients with renal failure (HR, 1.61; 95% CI, 1.28-2.02; P < .001) and diabetes (HR, 1.61; 95% CI, 1.36-1.92; P < .001) who were taking cilostazol. Conclusions In patients undergoing LER, cilostazol use was associated with improved 1-year freedom from amputation. Patients with renal failure and diabetes also demonstrated a significant benefit from taking cilostazol. Further studies are needed to evaluate the benefits of cilostazol after LER. [ABSTRACT FROM AUTHOR]

Context The Caregiver Pain Medicine Questionnaire is designed to measure caregiver agreement with statements regarding pain management. However, little testing has been done to determine its reliability and validity. Objectives The objective of the study was to test the factorial validity of scores from the Caregiver Pain Medicine Questionnaire as hypothesized by the original study authors. Methods Confirmatory factor analysis was conducted to assess whether the subscales postulated by the instrument authors could be replicated in external data. Results Fit statistics reveal an unsatisfactory fit between the hypothesized model and the observed data. Conclusion The theoretical model hypothesized by the original study authors was not confirmed. Results lead us to conclude that the instrument is poor and should not be used. Further research is needed to define content domains and validate the items developed to assess them. [ABSTRACT FROM AUTHOR]

Objective: The impact of interventions for critical limb ischemia (CLI) on functional status in the elderly remains unclear. Open and endovascular procedures were evaluated. Methods: Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for lower extremity procedures for CLI. A functional impairment score (0-28; higher scores indicating greater impairment) based on residents' need for assistance with self-care activities, walking, and locomotion was calculated before and after interventions. Hierarchical modeling determined the effect of the surgery on residents' function, controlling for comorbidity, cognition, and prehospital function. Results: Three hundred fifty-two and 350 patients underwent open and endovascular procedures, respectively (rest pain, 84; ulceration, 351; gangrene, 267). Hospitalization was associated with a significant worsening in function following both procedures. Disease severity was associated with the amount of initial decline but not with the rate of recovery (P > .35). Residents who received open surgery improved more quickly following hospital discharge (P = .011). Conclusions: In the frail elderly, open and endovascular procedures for CLI were associated with similar initial declines in functional status, suggesting that compared with open procedures, less invasive endovascular procedures were not associated with maintaining baseline function. In this select population, endovascular procedures for CLI were not associated with improved functional status over time compared with open. Six months posthospital, patients who received traditional open bypass had significantly better functional status than those who received endovascular procedures for all CLI diagnoses. Further analysis is required to assist stakeholders in performing procedures most likely to preserve functional status in the frail elderly and nursing home population. [Copyright &y& Elsevier]

Objective: As pressure to contain health care costs increases, there has been greater scrutiny of readmissions in the vascular surgery population. The objective of this study was to evaluate postoperative readmissions after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD). Methods: A retrospective cohort study was performed of elective adult inpatients with PAD and LE procedures which were selected from the Health Facts database (Cerner Corporation, Kansas City, Mo) between October 2008 and December 2010 using International Classification of Disease, 9th Clinical Modification diagnosis codes (claudication, rest pain, and ulceration/gangrene) and procedure codes for LE revascularization (endovascular and open). Multivariable logistic regression and X² were used to compare patients who received endovascular and open procedures. The Charlson Comorbidity Index, comorbid diagnoses, and laboratory results were used to adjust for confounding. The main outcome measure evaluated was readmission ≤30 days of discharge. Results: Of 463,362 index admissions, 16,574 patients were identified with a diagnosis of PAD. Combining PAD with elective LE procedures during the index admission, 777 underwent open and 681 underwent endovascular procedures. Unadjusted readmission rates for open and endovascular procedures for claudication, rest pain, and ulceration/gangrene were 10.2% vs 11.3% (P = .69), 14.0% vs 18.2% (P = .43), and 21.1% vs 19.5% (P = .69), respectively. Readmission increased by the severity of the diagnosis for open and endovascular procedures (P = .0006). Men comprised 58% of the cohort; readmission rates were not statistically different by sex (P = .19). Race was not associated with procedure performed (P = .16), but nonwhite race was associated with more severe PAD (P < .0001). After adjusting for race, sex, comorbidities, length of stay, and laboratory values outside of normal reference ranges, the association between an endovascular procedure and readmission was not statistically significant (odds ratio, 1.28; 95% confidence interval, 0.94-1.75). Conclusions: Less invasive endovascular procedures were not associated with decreased readmission rates compared with open surgery. The overall readmission rate for claudicant patients was 10.7%, which was unexpectedly high. Predictors of readmission included male sex, longer hospital stays, hospital infection, elevated aspartate aminotransferase, and high numbers of medications ordered and dispensed. Further examination exploring reasons for readmission are required to decrease readmission rates in the vascular surgery population. [ABSTRACT FROM AUTHOR]

Abstract Objective We evaluated the association between postoperative hyperglycemia and outcomes after abdominal aortic aneurysm (AAA) repair. Methods We used diagnosis and procedure codes (International Classification of Diseases, Ninth Revision, Clinical Modification) to identify patients who underwent open or endovascular repair of a nonruptured AAA from September 2008 to March 2014 from the Cerner Health Facts database (Cerner Corporation, North Kansas City, Mo). We evaluated the association between postoperative hyperglycemia (glucose concentration >180 mg/dL) and infections, in-hospital mortality, readmission, patients' characteristics, length of hospital stay, and medications. Multivariable logistic models examined the association of postoperative hyperglycemia with in-hospital infection and mortality. Results Of 2478 patients, 2071 (83.5%) had good postoperative glucose control (80-180 mg/dL), and 407 (16.5%) had suboptimal control (hyperglycemia). Patients who had postoperative hyperglycemia experienced longer hospital stays (9.5 vs 4.7 days; P <.0001), higher infection rates (18% vs 8%; P <.0001), higher in-hospital mortality (8.4 vs 1.2%; P <.0001), and more acute complications (ie, acute renal failure, fluid and electrolyte disorders, respiratory complications). After adjusting for patients' characteristics and medications, multivariable logistic regression models demonstrated that patients receiving postoperative insulin had nearly 1.6 times the odds of having an infectious complication (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.12-2.2; P =.007) than those who did not. Hyperglycemic patients had 3.5 times the odds of in-hospital mortality (OR, 3.48; 95% CI, 1.78-6.80 [ P =.0003]; 2.3% vs 1.2%; P <.001). When stratified by procedure type, patients with hyperglycemia who underwent endovascular repair had nearly 2 times the odds of an infectious complication (OR, 1.85; 95% CI, 0.98-3.51; P =.05) and 7.5 times the odds of in-hospital mortality (OR, 7.54; 95% CI, 1.95-29.1; P =.003). Patients who underwent an open AAA repair and who had hyperglycemia had three times the odds of dying in the hospital (OR, 3.05; 95% CI, 1.29-7.21; P =.01). Conclusions Among patients undergoing elective AAA repair, approximately one in six had postoperative hyperglycemia. After AAA repair in patients with and without diabetes, postoperative hyperglycemia was associated with adverse events, including in-hospital mortality and infections. Compared with those who had open surgery, patients undergoing endovascular repair who had postoperative hyperglycemia had greater risk of infection and death. After controlling for insulin administration and postoperative hyperglycemia, a diabetes diagnosis was associated with lower odds of both infection and in-hospital mortality. Our study suggests that hyperglycemia may be used as a clinical marker as it was found to be significantly associated with inferior outcomes after elective AAA repair. This retrospective study, however, cannot imply causation; further study using prospective methods is needed to elucidate the relationship between postoperative hyperglycemia and patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: The ability of nursing home residents to function independently is associated with their quality of life. The impact of amputations on functional status in this population remains unclear. This analysis evaluated the effect of amputations—transmetatarsal (TM), below-knee (BK), and above-knee (AK)—on the ability of residents to perform self-care activities. Methods: Medicare inpatient claims were linked with nursing home assessment data to identify admissions for amputation. The Minimum Data Set Activities of Daily Living Long Form Score (0-28; higher numbers indicating greater impairment), based on seven activities of daily living, was calculated before and after amputation. Hierarchical modeling determined the effect of the surgery on postamputation function of residents. Controlling for comorbidity, cognition, and prehospital function allowed for evaluation of Activities of Daily Living trajectories over time. Results: In total, 4965 residents underwent amputation: 490 TM, 1596 BK, and 2879 AK. Mean age was 81 years, and 54% of the patients were women. Most were white (67%) or black (26.5%). Comorbidities before amputation included diabetes mellitus (70.7%), coronary heart disease (57.1%), chronic kidney disease (53.6%), and/or congestive heart failure (52.1%). Mortality within 30 days of hospital discharge was 9.0%, and hospital readmission was 27.7%. Stroke, end-stage renal disease, and poor baseline cognitive function were associated with the poorest functional outcome after amputation. Compared with residents who received TM amputation, those who had BK or AK amputation recovered more slowly and failed to return to baseline function by 6 months. BK was found to have a superior functional trajectory compared with AK. Conclusions: Elderly nursing home residents undergoing BK or AK amputation failed to return to their functional baseline within 6 months. Among frail elderly nursing home residents, higher amputation level, stroke, end-stage renal disease, poor baseline cognitive scores, and female sex were associated with inferior functional status after amputation. These factors should be strongly assessed to maintain activities of daily living and quality of life in the nursing home population. [Copyright &y& Elsevier]

Context: Family caregivers play a vital role in managing the pain of hospice patients with cancer; however, caregivers' knowledge of pain management principles and experiences as pain managers vary widely. Differences in cultural values and access to resources suggest that rural and urban hospice family caregivers may differ with regard to their pain knowledge and experience, but this has not been empirically investigated.Objectives: We sought to determine if rural and urban hospice family caregivers differed in terms of their knowledge of cancer pain management principles and their experiences managing cancer pain.Methods: Our study consisted of a secondary analysis of baseline, cross-sectional data from hospice family caregivers (N = 196) participating in an ongoing cluster randomized crossover pragmatic trial. We performed multivariable regression to model associations between caregivers' demographic characteristics and their scores on the Family Pain Questionnaire (FPQ), which included subscales measuring pain knowledge and experience.Results: When controlling for other demographic variables, rural caregivers' scores on the FPQ knowledge subscale were worse (P = 0.01) than their urban counterparts. FPQ experience subscale scores and FPQ total scores were not statistically significantly different between the two groups.Conclusion: Rural hospice family caregivers report greater pain knowledge deficits than urban hospice family caregivers, although the two groups report comparable pain management experiences. Additional research is needed to better explain observed differences. [ABSTRACT FROM AUTHOR]

Context: Family caregivers play a central role in the care of those in hospice care. Little is known about the social support networks for those providing this day-to-day care without training.Objectives: The purpose of this study was to explore changes in family and friend social networks among hospice caregivers over the course of the hospice stay.Methods: Data on social support networks were collected as part of a multisite randomized controlled trial and analyzed using structural equation modeling.Results: A statistically significant decline in the caregivers' family network subscale score was found over the four week period during which they received hospice services, reflecting a possible weakening of their family networks.Conclusion: This result illustrates the potential importance of ongoing comprehensive assessment of caregiver networks and attention to interventions that may assist in capitalizing on both the quantity of support (numbers of individuals asked to help) and the quality of social support (attending to issues of support burden). [ABSTRACT FROM AUTHOR]

Context: Those caring for their loved ones in hospice experience tremendous stress, being faced with numerous decisions as they work to manage the pain experienced by their loved one. Although hospice care teams create pain management strategies, it is the role of the caregiver to implement these plans.Objectives: The purpose of this study was to further understand the hospice caregiver experience relating to pain management.Methods: Semistructured interviews with 146 caregivers provided data for the study. Responses to seven questions asking for a ranking of end-of-life pain management indicated a less than ideal experience. Available narratives from 38 caregivers were analyzed for themes related to further understanding of the concerns.Results: Five themes were identified in the data including difficulty with administration of pain medicines, concerns about side effects of medications, insecurity with pain assessment, frustrations with communication among health care team members, and memories of unrelieved pain.Conclusion: These findings should raise concern among hospice professionals, whose commitment is to the management of pain, including emotional pain, with a focus on both the patient and the family as a unit of care. These data clearly suggest that hospice providers have an opportunity to be sensitive to perceptions held by caregivers regarding pain management. Effective planning for pain control must incorporate the values and beliefs not only of each patient but also of the family caregiver. [ABSTRACT FROM AUTHOR]

Abstract: Context: Low oral literacy has been identified as a barrier to pain management for informal caregivers who receive verbal instructions on pain medication and pain protocols. Objectives: To examine recorded communication between hospice staff and informal caregivers and explore caregiver experiences. Methods: Using transcripts of interactions (n = 47), oral literacy features were analyzed by examining the generalized language complexity using the Flesch-Kincaid grading scale and the dialogue interactivity defined by talking turns and interaction time. Means for longitudinal follow-up measures on caregiver anxiety, quality of life, perception of pain management, knowledge and comfort providing pain medication, and satisfaction were examined to explore their relationship to oral literacy. Results: Communication between team members and caregivers averaged a fourth-grade level on the Flesch-Kincaid scale, indicating that communication was easy to understand. Reading ease was associated (r = 0.67, P < 0.05) with caregiver understanding of and comfort with pain management. Perceived barriers to caregiver pain management were lower when sessions had increased use of passive sentences (r = 0.61, P < 0.01), suggesting that passive voice was not an accurate indicator of language complexity. Caregiver understanding and comfort with administering pain medications (r = −0.82, P < 0.01) and caregiver quality of life (r = −0.49, P < 0.05) were negatively correlated with dialogue pace. Conclusion: As the grade level of talk with caregivers and hospice teams increased, associated caregiver anxiety increased. Caregivers with higher anxiety also experienced greater difficulty in understanding pain medication and its management. Specific adjustments that hospice teams can make to improve caregiver experiences are identified. [Copyright &y& Elsevier]