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      The role, impact, and support of informal caregivers in the delivery of palliative care for patients with advanced cancer: A multi-country qualitative study

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          Abstract

          Background:

          Cancer is increasing in its prevalence in sub-Saharan Africa. Informal caregivers are key to supporting engagement and interaction with palliative care services, but limited literature on their role impedes development of supportive interventions.

          Aim:

          We aimed to understand the role, impact, and support of informal caregivers of patients with advanced cancer when interacting with palliative care services in Nigeria, Uganda, and Zimbabwe.

          Design:

          Secondary analysis of qualitative interview transcripts. The dataset was assessed for fit and relevance and framework approach was used.

          Setting/participants:

          Interview transcripts of informal caregivers included participants aged over 18 years of age recruited from palliative care services across participating countries.

          Results:

          A total of 48 transcripts were analyzed. Mean age was 37 (range 19–75) with equal numbers of men and women. Five themes emerged from the data: (1) caregivers are coordinators of emotional, practical, and health service matters; (2) caregiving comes at a personal social and financial cost; (3) practical and emotional support received and required; (4) experience of interacting and liaising with palliative care services; and (5) barriers and recommendations relating to the involvement of palliative care.

          Conclusions:

          The role of informal caregivers is multi-faceted, with participants reporting taking care of the majority of medical, physical, financial, and emotional needs of the care recipient, often in the face of sacrifices relating to employment, finances, and their own health and social life. Efforts to develop comprehensive cancer control plans in sub-Saharan Africa must take account of the increasing evidence of informal caregiver needs.

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          Most cited references49

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          Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

          This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.
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            Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

            Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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              What is an adequate sample size? Operationalising data saturation for theory-based interview studies.

              In interview studies, sample size is often justified by interviewing participants until reaching 'data saturation'. However, there is no agreed method of establishing this. We propose principles for deciding saturation in theory-based interview studies (where conceptual categories are pre-established by existing theory). First, specify a minimum sample size for initial analysis (initial analysis sample). Second, specify how many more interviews will be conducted without new ideas emerging (stopping criterion). We demonstrate these principles in two studies, based on the theory of planned behaviour, designed to identify three belief categories (Behavioural, Normative and Control), using an initial analysis sample of 10 and stopping criterion of 3. Study 1 (retrospective analysis of existing data) identified 84 shared beliefs of 14 general medical practitioners about managing patients with sore throat without prescribing antibiotics. The criterion for saturation was achieved for Normative beliefs but not for other beliefs or studywise saturation. In Study 2 (prospective analysis), 17 relatives of people with Paget's disease of the bone reported 44 shared beliefs about taking genetic testing. Studywise data saturation was achieved at interview 17. We propose specification of these principles for reporting data saturation in theory-based interview studies. The principles may be adaptable for other types of studies.
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                Author and article information

                Journal
                Palliat Med
                Palliat Med
                PMJ
                sppmj
                Palliative Medicine
                SAGE Publications (Sage UK: London, England )
                0269-2163
                1477-030X
                23 December 2020
                March 2021
                : 35
                : 3
                : 552-562
                Affiliations
                [1 ]Department of Social Work, University of Lagos, Lagos, Nigeria
                [2 ]Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
                [3 ]Patient-Centred Outcomes Group, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Leeds, UK
                [4 ]Department of Sociology, University of Lagos, Lagos, Nigeria
                [5 ]Clinical Trials Research Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
                [6 ]Department of Internal Medicine, Makerere University, Kampala, Uganda
                [7 ]African Palliative Care Association, Kampala, Uganda
                [8 ]Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
                [9 ]Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
                [10 ]Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
                Author notes
                [*]Matthew J Allsop, Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, West Yorkshire LS2 9LU, UK. Email: m.j.allsop@ 123456leeds.ac.uk
                [†]

                These authors contributed equally to the manuscript.

                Author information
                https://orcid.org/0000-0002-3588-3187
                https://orcid.org/0000-0001-5032-4714
                https://orcid.org/0000-0002-7399-0194
                Article
                10.1177_0269216320974925
                10.1177/0269216320974925
                7975852
                33353484
                10ab50d0-f1e6-4425-b680-a9cf8e5a86d0
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Funding
                Funded by: Research England, ;
                Award ID: University of Leeds QR GCRF
                Funded by: Medical Research Council, FundRef https://doi.org/10.13039/501100000265;
                Award ID: MR/S014535/1
                Categories
                Original Article
                Custom metadata
                ts1

                Anesthesiology & Pain management
                palliative care,caregivers,neoplasms,africa south of the sahara,qualitative research

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