Automated intra-operative SMS message updates: a quality improvement initiative to relieve caregivers’ worries (Preprint)

BACKGROUND Undergoing a surgical procedure is anxiety provoking for patients and their caregivers. During the intra-operative period, caregivers seek out informational updates from healthcare professionals, a situation complicated by COVID-19 health measures that require caregivers to wait outside the hospital. SMS-based communication that allows caregivers to follow their loved ones through surgery has shown promise in relieving anxiety and improving satisfaction with overall care. This form of communication is also well accepted by healthcare professionals and may be effective at relieving staff burden. OBJECTIVE Here we describe a quality improvement initiative of a standardized and integrated intra-operative SMS-based system to improve communication between surgical teams and caregivers. The main goal was to reduce caregiver anxiety; secondary goals included improving satisfaction with care and not increasing staff burden. METHODS A large tertiary care hospital offered the SMS service to caregivers who were waiting for loved ones undergoing surgery. SMS messages were integrated into the clinical information system software and sent at key points during the surgical journey to phone numbers provided by caregivers. A satisfaction survey was sent to caregivers one business day after surgery. Data were collected between Feb 16th and July 14th 2021. RESULTS Of the 8,129 surgeries scheduled, caregivers waiting for 6,149 surgeries (76%) agreed to receive SMS messages. A total of 34,129 messages were sent. The satisfaction survey was completed by 2,088/6,149 or 34 % of caregivers. Satisfaction with messages was high, with the majority of respondents reporting the messages received were adequate (71%), clear (74%), informative (72%) and met their needs (60%). Receiving text messages reduced caregiver anxiety (score 8.5 out of 10) and the overall satisfaction score was high (4.5 out of 5). Technical errors were reported by 111 caregivers. Suggestions for improvements included having messages sent more often, providing greater patient detail and being offered in other languages. CONCLUSIONS This digital health initiative provided SMS messages that were standardized and systematically sent to caregivers waiting for their loved ones undergoing surgery. This in turn decreased caregiver anxiety, with no additional burden to staff. In creating digital healthcare innovations, what patients and their families find useful and appreciated will ultimately determine uptake. Thus, caregiver feedback will inform future iterations of this initiative.

Families Matter: A Cross-Sectional Study of Parent and Child Mental Health During COVID-19 (Preprint)

BACKGROUND Background: The pandemic has disrupted all aspects of children’s lives and has increased children’s exposure to adversity and traumas known to increase the risk of mental health challenges. Recent studies have reported increased rates of mental health challenges in youth during the pandemic, yet few studies have examined the impact of the pandemic on the mental health of toddlers, preschoolers, and elementary school-age children. The pandemic has also adversely impacted caregiver mental health and other indirect factors, including economic instability, known to increase children’s risk for impairing mental health challenges. OBJECTIVE Objective: This study aimed to characterize the social-emotional challenges of children ages 2 to 12 years old during the pandemic and identify modifiable child, caregiver, and family-related risk factors that contribute to risk and are additional targets for intervention. METHODS Methods: Caregivers (N = 676) of children ages 2-12 completed an online survey in early fall 2021 using standardized screening tools to assess child social-emotional challenges and caregiver anxiety and depression. We used a new 16 scale to assess the impact of the pandemic at the child, caregiver, and family levels. We used hierarchical linear regression and logistic regression to explore the relationship between children’s mental health and caregivers’ mental health. We used path analysis to explore direct and indirect effects of the impact of pandemic stress on child emotional and peer challenges, mediated by caregiver anxiety and depression. RESULTS Results: Eighty-seven percent of the children were ages 2-8 years old (n=588) with 13% (n=88) between 9-12 years old. Caregivers endorsed significant child emotional and peer challenges with 80% (n = 536) of children at risk for clinically-significant emotional challenges and 57% (n = 388) at risk for clinically-significant peer social challenges. Emotional challenges increased with age (r = .20, P <.001). 50% (n=330) of caregivers screened positive for generalized anxiety and 24% (n=160) screened positive for depression. Cumulative COVID-19 impact was directly associated with increased child emotional challenges (r=.29, P<.001), peer challenges (r=.29, P<.001), caregiver anxiety (r = .32, P<.001), and caregiver depression (r = .42, P<.001). Caregiver anxiety accounted for 31% of the total effect of COVID-19 impact on child emotional challenges and 18% of the total effect on peer challenges. CONCLUSIONS Conclusions: The results of our study show that the COVID-19 pandemic is having direct and indirect adverse impacts on the social-emotional health of children ages 2 to 12 years old with impacts on very young children similar to impacts for older children. Only with an integrated, family-focused approach that includes young children will we be able to mitigate the current pediatric mental health crisis. CLINICALTRIAL n/a

Exploration of Parkinson’s Disease Symptomatology Subtypes From the Caregiver Perspective: Implications for Caregiver Burden, Depression, and Anxiety

Background: While research has demonstrated associations between Parkinson’s disease (PD) severity and caregiver burden and emotional functioning, less is known about the associations between specific PD symptom patterns and caregiver functioning. Objective: The purpose of the current study was to explore symptomatology subtypes in PD from the caregiver perspective in the U.S. and Mexico and to determine whether caregiver burden, depression, or anxiety differed by PD symptomatology subtype. Methods: Two hundred fifty-three caregivers ( M age = 59.9) completed Parts I and II of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), the Zarit Burden Interview, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scales. Results: Cluster analysis using domains from the MDS-UPDRS revealed 5 symptomatology subtypes: pain/motor predominant, low symptoms, severe diffuse symptoms, moderate restricted symptoms with speech/oral predominant, and mood predominant. Caregiver burden was greatest for caregivers of individuals in the severe diffuse symptom and moderate restricted symptoms with speech/oral predominant clusters. High caregiver depression and caregiver anxiety were observed in all clusters other than the low symptoms cluster. There were no site by cluster interactions, suggesting that symptom patterns contribute to caregiver functioning in similar ways in the U.S. and Mexico. Conclusions: This data-driven analysis revealed 5 symptomatology subtypes of PD from caregivers’ perspectives and highlighted the need for treatments and interventions based on predominant PD symptom expression. Importance of caregiver support across various symptomatology expressions, and particularly on specialist treatment for predominant speech/oral difficulties was recommended.

Vocalisation and physiological hyperarousal in infant-caregiver dyads where the caregiver has elevated anxiety

Co-regulation of physiological arousal within the caregiver-child dyad precedes later self-regulation within the individual. Despite the importance of unimpaired self-regulatory development for later adjustment outcomes, little is understood about how early co-regulatory processes can become dysregulated during early life. Aspects of caregiver behaviour, such as patterns of anxious speech, may be one factor influencing infant arousal dysregulation. We made day-long, naturalistic biobehavioural recordings in home settings in caregiver-infant dyads using wearable autonomic devices and miniature microphones. We examined the association between arousal, vocalisation intensity and caregiver anxiety. Moments of high physiological arousal in infants were more likely to be accompanied by high caregiver arousal when caregivers had high self-reported trait anxiety. Anxious caregivers were more likely to vocalise intensely at states of high arousal, and produce intense vocalisations that occurred in clusters. High intensity vocalisations were associated with more sustained increases in autonomic arousal for both anxious caregivers and their infants. Caregiver vocal behaviour differs in anxious parents, co-occurs with dyadic arousal dysregulation and could contribute to physiological arousal transmission. Implications for caregiver vocalisation as an intervention target are discussed.

Artificial Intelligence for ADRD Caregivers: A Systematic Literature Review

Artificial intelligence (AI) may improve the care for persons with Alzheimer’s disease and related dementias (ADRD) and caregivers’ quality of life. To examine existing research on this topic, we searched 5 publication databases using keywords related to Alzheimer’s, dementia, caregiver, and artificial intelligence, and found 113 relevant results. We then screened the titles, abstracts, and full texts, and excluded studies not including family caregivers, not involving providing information to users, screening/diagnosis of dementia, caregiver anxiety/burnout, or lacking empirical data. Thirty results remained. These studies included technologies such as robots to facilitate social engagement and assist with daily activities. Most were qualitative or cross-sectional with small samples. These studies generally reported positive outcomes in favor of AI tools but levels of evidence were low. These findings suggest the need for systematic designs that can generate high levels of evidence for the feasibility and efficacy of AI-based interventions for ADRD caregivers.

Caregiver-Centered Communication: A New Tool for Assessment of the Quality of Communication With Family Caregivers

Improved communication with caregivers can lead to reduced caregiver anxiety and burden, improved quality of life, and better coping during a stressful time. Even though caregiver communication with the health care team is essential in gerontology, we are lacking standardized instruments to assess quality of communication. We describe the initial development and testing of the Caregiver Centered Communication Questionnaire (CCCQ). The questionnaire has 30 items with 5 subscales: exchange of information, fostering health relationships with team/provider, recognizing and responding to emotions, managing care and decision making. We conducted a cross-sectional survey of 115 family caregivers of older adults in home care and hospice. Cronbach’s α for the scale was 0.97. Internal consistencies of subscales were high, ranging from 0.82 to 0.93. Preliminary testing indicates the potential of CCCQ in assessing engagement and quality of communication; further testing is required.

Linkage of Maternal Caregiver Smoking Behaviors on Environmental and Clinical Outcomes of Children with Asthma: A Post-Hoc Analysis of a Financial Incentive Trial Targeting Reduction in Pediatric Tobacco Smoke Exposures

(1) Background: Monthly variability in smoking behaviors in caregivers of pediatric asthmatics yields questions of how much and when does smoking reduction result in improved environmental and clinical outcomes. (2) Methods: Post hoc analysis of data from a 6 month pilot randomized-control trial occurring from May 2017 to May 2018 in Baltimore City (MD, USA). The initial trial’s primary intervention explored the utility of financial incentives in modifying caregiver smoking behaviors. Post hoc analyses examined all dyads independent of the initial trial’s randomization status. All caregivers received pediatric tobacco smoke harm reduction education, in addition to monthly encouragement to access the state tobacco quitline for individual phone-based counseling and nicotine replacement therapy. Maternal caregivers who were active cigarette smokers and their linked asthmatic child (aged 2–12 years) were grouped into two classifications (“high” versus “low”) based on the child and caregiver’s cotinine levels. A “low” cotinine level was designated by at least a 25% reduction in cotinine levels during 3 months of the trial period; achieving ≤2 months of low cotinine levels defaulted to the “high” category. Twenty-seven dyads (caregivers and children) (total n = 54) were assigned to the “high” category, and eighteen dyads (caregivers and children) (total n = 36) were allocated to the “low” category. The primary outcome measure was the correlation of caregiver cotinine levels with pediatric cotinine values. Secondary outcomes included asthma control, in addition to caregiver anxiety and depression. (3) Results: Caregivers with 3 months of ≥25% decrease in cotinine levels had a significantly greater mean change in child cotinine levels (p = 0.018). “Low” caregiver cotinine levels did not significantly improve pediatric asthma control (OR 2.12 (95% CI: 0.62–7.25)). Caregiver anxiety and depression outcomes, measured by Patient Health Questionnaire (PHQ)-4 scores, was not significantly different based on cotinine categorization (p = 0.079); (4) Conclusion: Reduced pediatric cotinine levels were seen in caregivers who reduced their smoking for at least 3 months, but clinical outcome measures remained unchanged.