Preparedness, resilience and unmet needs of informal caregivers of advanced cancer patients in a Regional Mission Hospital in Kenya: Qualitative Study

Classified as probably not a substantial claim. May combine two claims.

A study reported significant challenges for patients living with advanced cancer and their informal caregivers, including persistent physical symptoms, psychosocial concerns, difficulties with coordination of care, and possible lack of available resources and supports if the person is no longer being followed by cancer health care professionals.

“A study assessing unmet needs of patients living with advanced cancer and their informal caregivers report significant challenges, including persistent physical symptoms and psychosocial concerns, difficulties with coordination of care, and possible lack of available resources and supports if the person is no longer being followed by cancer health care professionals [2].”

• cites [2] Booker R, Bays S, Burnett L, Torchetti T. Supporting People and Their Caregivers Living with Advanced Cancer: From Individual Experience to a National Interdisciplinary Program. Semin Oncol Nurs. 2021;37(4):151169. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

A study found a considerably high prevalence of depression in cancer patients' caregivers.

“In a study to estimate the prevalence rate of depression in cancer patient informal caregivers and to identify factors affecting depression and quality of life of cancer caregivers found out that a considerably high prevalence of depression is found in cancer patients’ caregivers.”

• cites [13] Geng HM, Chuang DM, Yang F, Yang Y, Liu WM, Liu LH, et al. Prevalence and determinants of depression in caregivers of cancer patients: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(39):e11863. sourceSupported

May combine two claims.

Resilience may be critical to informal caregivers' abilities to manage stress, be effective sources of support to patients, and feel ready to make future medical decisions on behalf of patients.

“studies have shown that resilience may be critical to informal caregivers' abilities to manage stress, be effective sources of support to patients, and feel ready to make future medical decisions on behalf of patients [3, 7].”

• cites [3] Dionne-Odom JN, Azuero A, Taylor RA, Wells RD, Hendricks BA, Bechthold AC, et al. Resilience, preparedness, and distress among family caregivers of patients with advanced cancer. Support Care Cancer. 2021;29(11):6913–20. sourceSupported
• cites [7] van Roij J, Brom L, Sommeijer D, van de Poll-Franse L, Raijmakers N. Self-care, resilience, and caregiver burden in relatives of patients with advanced cancer: results from the eQuiPe study. Support Care Cancer. 2021;29(12):7975–84. sourcePartly supported

  The Background (page unavailable) says resilience may help informal caregivers adapt to negative events and bear caregiving burden, which supports the stress-management part of the claim. The Results associate greater resilience with lower caregiver burden. Neither passage establishes that resilience makes caregivers more effective sources of support to patients or more ready to make future medical decisions for them. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Caregiving must be balanced against pre-existing roles and duties.

“In addition, caregiving must be balanced against pre-existing roles and duties [3].”

• cites [3] Dionne-Odom JN, Azuero A, Taylor RA, Wells RD, Hendricks BA, Bechthold AC, et al. Resilience, preparedness, and distress among family caregivers of patients with advanced cancer. Support Care Cancer. 2021;29(11):6913–20. sourceCould not verify

  The Introduction describes substantial caregiving demands, and the Discussion describes a rapid accumulation of new tasks for family members. Neither passage addresses balancing caregiving against pre-existing roles or duties; searches for competing responsibilities and existing roles found no such passage in our copy. (LLM, conf=0.72)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Patients with cancer require a variety of services, including disease and treatment monitoring, symptom management, medication administration, emotional support, personal care assistance, and instrument care assistance.

“Patients with cancer require a variety of services, including disease and treatment monitoring, symptom management, medication administration, emotional support, personal care assistance, and instrument care assistance [2].”

• cites [2] Booker R, Bays S, Burnett L, Torchetti T. Supporting People and Their Caregivers Living with Advanced Cancer: From Individual Experience to a National Interdisciplinary Program. Semin Oncol Nurs. 2021;37(4):151169. sourcePartly supported

  The “Unmet Needs of Patients Living with Advanced Cancer” section describes needs for symptom management and psychosocial support, and the “Role of Community Programs and Services” section discusses practical and emotional support. The paper focuses on advanced cancer and does not substantiate the full list of services attributed to it, particularly medication administration, personal care assistance, and instrument care assistance. Page numbers are unavailable in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Previous studies show that factors associated with caregiver burden include previous hospitalisation of the care recipient and perceived dysfunction in patients' activities of daily living.

“Previous studies show that factors associated with caregiver burden include previous hospitalisation of the care recipient and perceived dysfunction in patients’ activities of daily living [1].”

• cites [1] Jite IE, Adetunji AA, Folasire AM, Akinyemi JO, Bello S. Caregiver burden and associated factors amongst carers of women with advanced breast cancer attending a radiation oncology clinic in Nigeria. Afr J Prim Health Care Fam Med. 2021;13(1):e1–8. sourceSupported

Classified as probably not a substantial claim.

Resilience among many informal caregivers of patients with advanced cancer has been suggested as a primary component in their ability to withstand psychological strain and function effectively in the task despite carrying a heavy load of caregiving responsibilities.

“Resilience among many informal caregivers of patients with advanced cancer has been suggested as a primary component in their ability to withstand psychological strain and function effectively in the task despite carrying a heavy load of caregiving responsibilities [3, 7].”

• cites [3] Dionne-Odom JN, Azuero A, Taylor RA, Wells RD, Hendricks BA, Bechthold AC, et al. Resilience, preparedness, and distress among family caregivers of patients with advanced cancer. Support Care Cancer. 2021;29(11):6913–20. sourceSupported
• cites [7] van Roij J, Brom L, Sommeijer D, van de Poll-Franse L, Raijmakers N. Self-care, resilience, and caregiver burden in relatives of patients with advanced cancer: results from the eQuiPe study. Support Care Cancer. 2021;29(12):7975–84. sourcePartly supported

  The Background (page not available) suggests resilience may help relatives of patients with advanced cancer bear caregiving burden and reports associations with less depression and better health. The Results also associate higher resilience with lower odds of high caregiver burden. The paper does not establish resilience as a primary component or show that it enables caregivers to function effectively in caregiving tasks. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Informal caregivers may require coaching and emotional support as a result of their own emotional reactions to the patients' diagnosis and prognosis.

“Furthermore, informal caregivers may require coaching and emotional support as a result of their own emotional reactions to the patients' diagnosis and prognosis [4].”

• cites [4] Kent EE, Rowland JH, Northouse L, Litzelman K, Chou WY, Shelburne N, et al. Caring for caregivers and patients: Research and clinical priorities for informal cancer caregiving. Cancer. 2016;122(13):1987–95. sourceSupported

Classified as probably not a substantial claim. May combine two claims.

Studies reported higher resilience associated with higher caregiver preparedness, higher readiness for surrogate decision-making, and lower anxiety and depressive symptoms.

“Whilst studies examining resiliency and preparedness of informal caregivers of advanced cancer patients reported higher resilience associated with higher caregiver preparedness, higher readiness for surrogate decision-making and lower anxiety and depressive symptoms [3, 8, 9]”

• cites [3] Dionne-Odom JN, Azuero A, Taylor RA, Wells RD, Hendricks BA, Bechthold AC, et al. Resilience, preparedness, and distress among family caregivers of patients with advanced cancer. Support Care Cancer. 2021;29(11):6913–20. sourceSupported
• cites [8] McDonald J, Swami N, Pope A, Hales S, Nissim R, Rodin G, et al. Caregiver quality of life in advanced cancer: Qualitative results from a trial of early palliative care. Palliat Med. 2018;32(1):69–78. sourceNot checked — no full text of the source
• cites [9] Phillips SS, Ragas DM, Tom LS, Hajjar N, Dong X, Simon MA. Voices of Informal Caregivers and Community Stakeholders: Whether and How to Develop an Informal Caregiver Training Program. J Community Health. 2016;41(3):550–6. sourceCould not verify

  The Introduction discusses economic resilience through caregiver training, while Methods > Analysis describes an examination of recommendations for that program; neither reports an association between resilience and preparedness, surrogate decision-making readiness, anxiety, or depressive symptoms. Searches for those associations and for advanced cancer caregivers found no relevant passage in our copy. Page numbers were not provided. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

One study has mentioned up to thirty different tasks that informal caregivers are involved in.

“One study has mentioned up to thirty different tasks that informal caregivers are involved in, the majority of which our informal caregivers shared [23].”

• cites [23] Glajchen M. Physical well-being of oncology caregivers: an important quality-of-life domain. Semin Oncol Nurs. 2012;28(4):226–35. sourcePartly supported

  The Adverse Physical Outcomes section lists many tasks performed by family caregivers, including personal care, household work and medication management. The Assessment of Caregivers’ Physical Well-being section also discusses the number and nature of caregiving tasks. Neither section reports a study identifying up to thirty distinct tasks, so the specific count is unsupported; page numbers are unavailable in our copy. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Female informal caregivers had significantly higher levels of perceived stress, depression, anxiety, and social strain compared with male caregivers.

“It is reported that female informal caregivers had significantly higher levels of perceived stress, depression, anxiety, and social strain compared with male caregivers [15].”

• cites [15] Ketcher D, Trettevik R, Vadaparampil ST, Heyman RE, Ellington L, Reblin M. Caring for a spouse with advanced cancer: similarities and differences for male and female caregivers. J Behav Med. 2020;43(5):817–28. sourcePartly supported

  The Results (page unavailable) report significantly higher perceived stress, depression, and anxiety among female than male spouse caregivers of patients with advanced cancer. The non-abstract Results and Discussion passages do not establish a significant difference in social strain, and the claim does not specify the study’s spouse-caregiver population. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In other studies, role strain correlates to the number of other competing roles, which in turn is determined by the stage of lifespan that a caregiver was in.

“In other studies, role strain correlates to the number of other competing roles, which in turn is determined by the stage of lifespan that a caregiver was in [1, 3]”

• cites [1] Jite IE, Adetunji AA, Folasire AM, Akinyemi JO, Bello S. Caregiver burden and associated factors amongst carers of women with advanced breast cancer attending a radiation oncology clinic in Nigeria. Afr J Prim Health Care Fam Med. 2021;13(1):e1–8. sourcePartly supported

  The Discussion (page unavailable) describes caregiving alongside paid employment and adult offspring’s responsibilities to their own families, supporting the idea of competing roles. It does not establish that role strain correlates with the number of competing roles or that this number is determined by a caregiver’s life stage; caregiver age was not significantly associated with perceived burden in this study. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites [3] Dionne-Odom JN, Azuero A, Taylor RA, Wells RD, Hendricks BA, Bechthold AC, et al. Resilience, preparedness, and distress among family caregivers of patients with advanced cancer. Support Care Cancer. 2021;29(11):6913–20. sourceCould not verify

  The Introduction and Discussion describe numerous caregiving tasks and stressors, but do not relate role strain to the number of competing roles or relate those roles to a caregiver’s life stage. Searches for “role strain” and “lifespan life stage competing roles” found no passage making that connection; the only exact mention of “role strain” was in a reference title. (LLM, conf=0.75)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Gender differences have been linked to differences in caregiver stress, burden, anxiety, depression, and coping styles, as well as how caregiver's gender impacts patient outcomes in the context of advanced cancer patients.

“Further, gender differences have been linked to differences in caregiver stress, burden, anxiety, depression, and coping styles, as well as how caregiver’s gender impacts patient outcomes in the context of advanced cancer patients [10, 14].”

• cites [10] Johansen S, Cvancarova M, Ruland C. The Effect of Cancer Patients' and Their Family Caregivers' Physical and Emotional Symptoms on Caregiver Burden. Cancer Nurs. 2018;41(2):91–9. sourceNot checked — no full text of the source
• cites [14] Ketcher D, Otto AK, Vadaparampil ST, Heyman RE, Ellington L, Reblin M. The Psychosocial Impact of Spouse-Caregiver Chronic Health Conditions and Personal History of Cancer on Well-being in Patients With Advanced Cancer and Their Caregivers. J Pain Symptom Manage. 2021;62(2):303–11. sourceCould not verify

  The Results (Sample Characteristics; page unavailable) report caregivers’ genders, but do not compare outcomes by gender. The Methods (Data Analysis; page unavailable) and Results instead examine chronic conditions and caregivers’ cancer history. Searches for gender differences and caregiver gender found no passage linking gender to caregiver stress, burden, anxiety, depression, coping styles, or patient outcomes. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A study has shown that caregiver labor costs were often unappreciated by their informal caregivers and completely unrecognized by the healthcare system at large.

“A study has shown that caregiver labor costs were often unappreciated by their informal caregivers and completely unrecognized by the healthcare system at large [22].”

• cites [22] Schulz R, Sherwood PR. Physical and mental health effects of family caregiving. Am J Nurs. 2008;108(9 Suppl):23–7 quiz 7. sourcePartly supported

  The Abstract (page unavailable) describes informal caregiving as unpaid work and says families provide services that would cost hundreds of billions of dollars annually if purchased. It does not say caregivers often fail to appreciate those costs or that the healthcare system completely fails to recognize them. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Evidence-based caregiver interventions are well documented.

“Whilst evidence-based caregiver interventions are well documented [16]”

• cites [16] Northouse LL, Katapodi MC, Song L, Zhang L, Mood DW. Interventions with family caregivers of cancer patients: meta-analysis of randomized trials. CA Cancer J Clin. 2010;60(5):317–39. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The majority of the thirty tasks mentioned in prior work were shared by the informal caregivers in this study.

“One study has mentioned up to thirty different tasks that informal caregivers are involved in, the majority of which our informal caregivers shared [23].”

• cites [23] Glajchen M. Physical well-being of oncology caregivers: an important quality-of-life domain. Semin Oncol Nurs. 2012;28(4):226–35. sourcePartly supported

  The Adverse Physical Outcomes section lists many tasks performed by oncology caregivers, including personal care, household work, transportation, paperwork and medication management. It does not state that there are up to thirty different tasks. The comparison with the citing authors’ own caregivers is their finding, not one this source could establish. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

Competing tasks and lack of preparedness in handling end-of-life care for patients in advanced stages of cancer were the main concerns of caregivers in this study.

“Competing tasks, lack of preparedness in handling end-of-life care for patients in advanced stages of cancer were the main concerns.”

May combine two claims.

Continued unmet needs, financial stresses, and vulnerability for female caregivers all contributed to increased caregiver burden in this study.

“Continued unmet needs and financial stresses, and vulnerability for female caregivers all contributed to increased caregiver burden in this study.”

May combine two claims.

Family caregivers had huge caregiver burden and insurmountable practical challenges related to role overload and competing tasks.

“Whilst family caregivers had huge caregiver burden, insurmountable practical challenges related to role overload and competing tasks”

May combine two claims.

Caregivers were determined and resilient amidst challenges that faced them, and exhibited hope against hopelessness.

“Caregivers were however determined and resilient amidst challenges that faced them, they exhibited hope against hopelessness.”

May combine two claims.

Some caregivers were vulnerable and faced potential for abuse following anticipated loss of their family member, which exacerbated psychosocial stress and needs.

“Some caregivers were vulnerable and faced potential for abuse following anticipated loss of their family member exacerbated psychosocial stress and needs”

May combine two claims.

Family caregivers remained resilient though unprepared in giving end-of-life care.

“they remained resilient though unprepared in giving end of life care.”

May combine two claims.

Children of informal caregivers feel the stress and can get overwhelmed.

“If the caregiver has parenting responsibilities, they need to be equipped on how to care for the children, as they too feel the stress, and can get overwhelmed.”

May combine two claims.

Tasks included medication acquisition and dispensing, symptom management, meals and nutritional assistance, supervision of treatments, adherence, emotional support, communication with the healthcare providers, and many others.

“Tasks included medication acquisition and dispensing, symptom management, meals and nutritional assistance, supervision of treatments, adherence, emotional support, communication with the healthcare providers, and many others.”

May combine two claims.

Two informal caregivers left their matrimonial homes to care for their loved ones; one with the blessing of her husband and the other with resistance from her husband.

“Two informal caregivers left their matrimonial homes to care for their loved ones; one with the blessing of her husband and the other with resistance from her husband.”

May combine two claims.

Basic activities of daily living such as feeding and toileting were difficult for patients and posed significant challenges for caregivers.

“In some cases, basic activities of daily living such as feeding and toileting were difficult for the patients, and this posed significant challenges for the caregiver.”

May combine two claims.

Hope for recovery was also shared by the church sometimes and perpetuated by it.

“This hope for recovery is also shared by the church sometimes and perpetuated by it.”

May combine two claims.

In the study setting, caregivers' contribution to the informal healthcare workforce goes unrecognized and uncompensated by the government and the healthcare system.

“This is similar to our setting where caregivers’ contribution to the informal healthcare workforce goes unrecognized and uncompensated by the government and the healthcare system.”

Classified as probably not a substantial claim. May combine two claims.

The other competing realities of life like farm work, childcare and other social responsibilities remained, and no provision was made to adjust effects of the impact to informal caregivers of cancer patients.

“The other competing realities of life like farm work, childcare and other social responsibilities remained, and no provision was made to adjust effects of the impact to informal caregivers of cancer patients.”

May combine two claims.

The majority of informal caregivers were strained, stressed and felt helpless in the face of impending death of their loved ones.

“The majority were strained, stressed and felt helpless in the face of impending death of their loved ones.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A 67-year-old husband caregiver of a wife with advanced esophageal cancer reported having no maid or money to employ one and did cooking, boiling drinking water, and laundry.

“Another caregiver (husband) taking care of his wife who had advanced esophageal cancer reported:”

• Also stated in: § Resilience · plain

  “I have no maid, I don’t have any money to employ one…. I cook for her; I boil for her drinking water …. I do her laundry”

May combine two claims.

Majority of informal caregivers experienced difficulties of having to face expensive or costly treatments with limited resources or a times unhelpful state-cover insurance (NHIF) and hence found disposing of assets and good the only option and way out.

“Majority experienced difficulties of having to face expensive or costly treatments with limited resources or a times unhelpful state-cover insurance (NHIF) and hence found disposing of assets and good the only option and way out.”

Classified as probably not a substantial claim. May combine two claims.

Informal caregivers continue to face unlimited challenges in their caregiving including unmet needs at individual-level.

“Informal caregivers continue to face unlimited challenges in their caregiving including unmet needs at individual-level.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A 41-year-old daughter caring for a mother with advanced pancreatic cancer and a 35-year-old daughter-in-law prayed for God's strength or intervention.

“A 41-year-old daughter prays for God’s strength to keep caring for their mother who has advanced pancreatic cancer and as does a 35-year-old daughter in law who prays for God’s intervention”

Probably not a substantial claim: may not pass S3 (load-bearing).

A 26-year-old female caregiver of a sister with advanced gastric cancer expressed psychosocial effects of caring for a patient at end of life.

“Another 26-year-old female caring for a sister with advanced gastric patient expresses psychosocial effects of caring for a patient at end of life”

Probably not a substantial claim: may not pass S3 (load-bearing).

A 41-year-old respondent left her matrimonial home to care for her mother.

“One respondent aged 41 who left her matrimonial home to care for her mother said:”

May combine two claims.

A 26-year-old caregiver of a sister with advanced gastric cancer had no prior training or preparedness and provided care from willingness.

“Another 26-year-old reports of caring for their family member (sister) with advanced Gastric cancer with no prior training or preparedness, but simply offering care”

• Also stated in: § Data analysis · plain

  “I have not gotten any training to take care of her. It just comes from my willingness”

May combine two claims.

The mental and psychological effects were due to anxieties of what next, should the patient die; occasionally, it was due to anticipated grief.

“The mental and psychological effects were due to anxieties of what next, should the patient die. Occasionally, it was due to anticipated grief.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A 41-year-old female caregiver of an advanced pancreatic cancer patient reported lack of knowledge on what to do next and did what she knew best.

“In one other case, a 41-year-old female caregiver caring for advanced pancreatic cancer patient reported lack of knowledge on what to do next for their patient and stated that so and state that she simply does what she knows best.”

May combine two claims.

Though informal caregivers were resilient, they were overwhelmed with their caregiving role amidst other competing tasks, had increasing unmet needs which negatively impacted on their quality of life.

“Though informal caregivers were resilient, they were overwhelmed with their caregiving role amidst other competing tasks, had increasing unmet needs which negatively impacted on their quality of life.”

May combine two claims.

End-of life care needs, information needs, and coping strategies remained largely unaddressed among many informal caregivers of advanced cancer patients.

“End-of life care needs, information needs, and coping strategies remained largely unaddressed among many informal caregivers of advanced cancer patients:”

May combine two claims.

Some unmet needs of informal caregivers include lack of network of support, psychological impact of caregiving with no resources to support them, and helplessness related to hopeless situation or state of caregiving.

“Some of their unmet needs include lack of network of support, psychological impact of caregiving with no resources to support them, helplessness related to hopeless situation or state of caregiving.”

May combine two claims.

Most families in this study had depleted their savings and resources and were getting poorer with financial demands each day.

“As such, most families had depleted their savings and resources and were getting poorer with financial demands each day.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

As the disease progressed, the level of patient dependence increased, and so does the demands on the caregiver.

“As the disease progressed, the level of patient dependence increased, and so does the demands on the caregiver.”

May combine two claims.

This study revealed lack of priorities and ways of integrating informal caregivers into formal health care settings.

“This study revealed lack of priorities and ways of integrating informal caregivers into formal health care settings.”

Probably not a substantial claim: may not pass S2 (checkable).

The study showed that there are a lot of unaddressed issues for further investigation along primary caregiving experiences which merit inquiry.

“The study showed that there are a lot of unaddressed issues for further investigation along primary caregiving experiences which merit inquiry.”

May combine two claims.

Resiliency was also evident among some informal caregivers who when faced with state of hopelessness, they did not give up instead, they found coping strategies and pushed on with their caregiving.

“Resiliency was also evident among some informal caregivers who when faced with state of hopelessness, they did not give up instead, they found coping strategies and pushed on with their caregiving.”

May combine two claims.

Though some reported difficulties in care-giving, they overcame all odds and supported their family member(s) suffering from advanced cancer.

“Though some reported difficulties in care-giving, they overcame all odds and supported their family member(s) suffering from advanced cancer.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Caregiver 6 spoke of a time when she physically felt unwell, and required hospitaladmission before they realized that she was simply overwhelmed, and had counseling prior to discharge.

“Caregiver 6 spoke of a time when she physically felt unwell, and required hospitaladmission before they realized that she was simply overwhelmed, and had counseling prior to discharge.”

May combine two claims.

Other mental roles include deciding on when the patient required attention and where to take them.

“Other mental roles include deciding on when the patient required attention and where to take them.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Other informal caregivers have sacrificed a lot in their support.

“Other informal caregivers have sacrificed a lot in their support.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A study revealed increased caregiver burden in family caregivers influenced by interplay of patients' and their own symptoms and problems.

“A study assessing the effect of cancer patients' and their informal caregivers' physical and emotional symptoms on caregiver burden, revealed increased caregiver burden in family caregiver influenced by interplay of patients' and their own symptoms and problems [10].”

• cites [10] Johansen S, Cvancarova M, Ruland C. The Effect of Cancer Patients' and Their Family Caregivers' Physical and Emotional Symptoms on Caregiver Burden. Cancer Nurs. 2018;41(2):91–9. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

There were significant associations between caregiver burden and patient-related variables such as self-efficacy, sleep disturbance, social support, fatigue and symptoms.

“For instance, there were significant associations between caregiver burden and the patient-related variables such as self-efficacy, sleep disturbance, social support, fatigue and symptoms.”

• cites [10] Johansen S, Cvancarova M, Ruland C. The Effect of Cancer Patients' and Their Family Caregivers' Physical and Emotional Symptoms on Caregiver Burden. Cancer Nurs. 2018;41(2):91–9. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interventions recommended include assessing the caregiver's situation and needs, such as referring to appropriate services and resources, which is critical for wellbeing of caregiver.

“Interventions recommended include assessing the caregiver's situation and needs such as referring to appropriate services and resources which is critical for wellbeing of caregiver [12].”

• cites [12] Alam S, Hannon B, Zimmermann C. Palliative Care for Family Caregivers. J Clin Oncol. 2020;38(9):926–36. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Field notes were taken during and right after each interview to ensure reflexivity.

“To ensure reflexivity, field notes were taken both during and right after each interview.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The research team deliberated each topic and concept's applicability to the study issue until agreement was obtained.

“The research team deliberated each topic and concept's applicability to the study issue until agreement was obtained [18].”

• cites [18] Smith JAFP, Larkin M. Interpretative phenomenological analysis. Theory, method and research. London: SAGE; 2009.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

A collaborative interdisciplinary team used in-case and across-case assessments to confirm the themes' applicability.

“a collaborative interdisciplinary team used in-case and across-case assessments to confirm the themes' applicability.”

May combine two claims.

Informal caregivers play a key role in palliative care in sub-Saharan Africa, a context fraught with inadequate healthcare services coupled with poverty, making home-based care the only available option for many chronically and terminally ill persons.

“Informal caregivers play a key role in palliative care in sub-Saharan Africa, a context fraught with inadequate healthcare services coupled with poverty, making home-based care the only available option for many chronically and terminally ill persons [21].”

• cites [21] Downing J, Powell R, Mwangi-Powell F. Home-Based Palliative Care in sub-Saharan Africa. Home Healthc Nurse. 2010;28:298–307. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Lack of acceptance of death made it a challenge for the interviewer to explore end-of-life symptoms and management.

“As such, given the lack of acceptance of death it was a challenge for the interviewer to explore end of life symptoms and management.”

Classified as probably not a substantial claim.

The study used a small number of participants as recommended by interpretative phenomenological analysis.

“As recommended by the interpretative phenomenological analysis (IPA) [18], only a small number of participants meeting inclusion criteria.”

• cites [18] Smith JAFP, Larkin M. Interpretative phenomenological analysis. Theory, method and research. London: SAGE; 2009.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The analysis was carried out in a controlled and traceable manner to assure trustworthiness and credibility.

“The analysis was carried out in a controlled and traceable manner to assure trustworthiness and credibility”

Probably not a substantial claim: may not pass S2 (checkable).

This study strengthens the need to raise awareness and equip informal caregivers with requisite knowledge and skills to face end-of life.

“This study strengthens the need to raise awareness and equip informal caregivers with requisite knowledge and skills to face end-of life.”

May combine two claims.

For informal caregivers who also had to care for their own children and other farm work, they would be expected to experience greater role-strain, and potentially be more overwhelmed, than caregivers who simply had one caregiving task alone.

“This implies that for informal caregivers who also had to care for their own children and other farm work would, therefore, be expected to experience greater role-strain, and potentially be more overwhelmed, than caregivers who simply had one caregiving task alone.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Erdwins and his colleagues had findings that supported the role-strain theory: that the more social roles a caregiver carries out, the more likely the caregiver is to experience stress, strain and negative affect.

“Erdwins and his colleagues had findings that supported the role-strain theory: that the more social roles a caregiver carries out, the more likely the caregiver is to experience stress, strain and negative affect [24].”

• cites [24] Erdwins C, Buffardi L, Casper W, O'Brien A. The Relationship of Women's Role Strain to Social Support, Role Satisfaction, and Self-Efficacy*. Family Relations. 2004;50:230–8. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

No objective assessments were done to assess informal caregivers' burden in this study.

“While there were no objective assessments done to assess informal caregivers’ burden, it did seem true in this study that informal caregivers, particularly those that had school going children experienced a greater burden contributing to increased unmet needs.”

Probably not a substantial claim: may not pass S2 (checkable).

This study provides sufficient evidence and basis to inform future practice of palliative and end of life care among informal caregivers facing complex coordination of tasks and logistics required to deliver needed care.

“This study provides sufficient evidence and basis to inform future practice of palliative and end of life care among informal caregivers facing complex coordination of tasks and logistics required to deliver needed care.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was done within a mission-based referral hospital which may not represent the true health care system in Kenya.

“Another limitation of this study includes settings; it was done within mission-based referral hospital which may not represent the true health care system in Kenya”