Caregiver-oncologist prognostic concordance, caregiving esteem, and caregiver outcomes

Kah Poh Loh; Erin Watson; Eva Culakova; Marie Flannery; Michael Sohn; Huiwen Xu; Sindhuja Kadambi; Allison Magnuson; Colin McHugh; Chandrika Sanapala; Lee Kehoe; Victor G Vogel; Brian L Burnette; Vincent Vinciguerra; Supriya G Mohile; Paul R Duberstein

doi:10.1016/j.jgo.2022.02.018

Caregiver-oncologist prognostic concordance, caregiving esteem, and caregiver outcomes

J Geriatr Oncol. 2022 Jul;13(6):828-833. doi: 10.1016/j.jgo.2022.02.018. Epub 2022 Mar 8.

Authors

Kah Poh Loh¹, Erin Watson², Eva Culakova³, Marie Flannery⁴, Michael Sohn⁵, Huiwen Xu⁶, Sindhuja Kadambi⁷, Allison Magnuson⁸, Colin McHugh⁹, Chandrika Sanapala¹⁰, Lee Kehoe¹¹, Victor G Vogel¹², Brian L Burnette¹³, Vincent Vinciguerra¹⁴, Supriya G Mohile¹⁵, Paul R Duberstein¹⁶

Affiliations

¹ Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: kahpoh_loh@urmc.rochester.edu.
² Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: erin_watson@urmc.rochester.edu.
³ Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: eva_culakova@urmc.rochester.edu.
⁴ School of Nursing, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: marie_flannery@urmc.rochester.edu.
⁵ Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: Michael_sohn@urmc.rochester.edu.
⁶ Preventive Medicine and Population Health University of Texas Medical Branch, Galveston, TX, USA. Electronic address: huiwen_xu@urmc.rochester.edu.
⁷ Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: sindhuja_kadambi@urmc.rochester.edu.
⁸ Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: allison_magnuson@urmc.rochester.edu.
⁹ Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: colin_mchugh@urmc.rochester.edu.
¹⁰ Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: chandrika_sanapala@urmc.rochester.edu.
¹¹ Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: lee_kehoe@urmc.rochester.edu.
¹² Geisinger Cancer Institute NCORP, Danville, PA, USA. Electronic address: vgvogel@geisinger.edu.
¹³ Cancer Research of Wisconsin and Northern Michigan (CROWN), Green Bay, WI, USA. Electronic address: brian.Burnette@gboncology.com.
¹⁴ Northwell Health, New York, USA. Electronic address: vvincigu@northwell.edu.
¹⁵ Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: supriya_mohile@urmc.rochester.edu.
¹⁶ Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA. Electronic address: paul.duberstein@rutgers.edu.

Abstract

Introduction: Caregiver-oncologist concordance regarding the patient's prognosis is associated with worse caregiver outcomes (e.g., depressive symptoms), but mechanisms underpinning these associations are unclear. We explored whether caregiving esteem mediates these associations.

Methods: At enrollment, caregivers and oncologists used a 5-point ordinal scale to estimate patient survival; identical responses were considered concordant. At 4-6 weeks, caregivers completed an assessment of the extent to which caregiving imparts self-esteem (Caregiver Reaction Assessment self-esteem subscale; range 0-5; higher score indicates greater esteem). They also completed Patient Health Questionnaire-2 (PHQ-2) for depressive symptoms, Distress Thermometer, and 12-Item Short Form Survey for quality of life (QoL). Mediation analysis with bootstrapping (PROCESS macro by Hayes) was used to estimate the extent to which caregiving mediated the effects of prognostic concordance on caregiver outcomes through caregiving esteem.

Results: Prognostic concordance occurred in 28% the caregiver-oncologist dyads; 85% of the discordance were due to caregivers estimating a longer patient's survival. At 4-6 weeks, mean caregiving esteem score was 4.4 (range 1.5-5.0). Lower caregiving esteem mediated the associations of concordance with higher PHQ-2 [indirect effect = 0.12; 95% Confidence Interval (CI) 0.03, 0.27], greater distress (indirect effect =0.25; 95% CI 0.08, 0.48), and poorer QoL (indirect effect = -1.50; 95% CI -3.06, -0.41). Caregiving esteem partially mediated 39%, 64%, and 48% of the associations between caregiver-oncologist concordance and PHQ-2, distress, and SF-12, respectively.

Conclusions: Caregiver-oncologist concordance was associated with lower caregiving esteem. Lower caregiving esteem mediated the negative relationship between caregiver-oncologist concordance and caregiver outcomes.

Keywords: Caregiver; Depressive symptom; Distress; Prognostic understanding; Quality of life.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Caregivers*
Humans
Oncologists*
Prognosis
Quality of Life
Surveys and Questionnaires

Abstract

Publication types

MeSH terms

Grants and funding