Caregiver Burden and Emergency Room Utilization for Enhanced Recovery Surgery Cancer Patients

Caregiver Burden and Emergency Room Utilization for Enhanced Recovery Surgery Cancer Patients by Mindy Sovel MS, Walden University, 2008 BA, Lehigh University, 1991 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Community Health Education Walden University February 2017 Abstract Advances in surgical technique and medical management have led to fundamental changes in surgical care allowing for a paradigm shift from inpatient to outpatient surgery. Enhanced recovery pathways have moved surgical recovery from inpatient to outpatient settings requiring informal caregiver support. The purpose of this study was to determine the prevalence of caregiver burden in this patient population and to exploreAdvances in surgical technique and medical management have led to fundamental changes in surgical care allowing for a paradigm shift from inpatient to outpatient surgery. Enhanced recovery pathways have moved surgical recovery from inpatient to outpatient settings requiring informal caregiver support. The purpose of this study was to determine the prevalence of caregiver burden in this patient population and to explore whether caregiver burden contributes to preventable use of emergency room services. The conceptual framework supporting this retrospective cross-sectional study was Andersen’s behavioral model of health services utilization. Data collected from 28 urologic patient/caregiver pairs were analyzed using descriptive statistics and linear and logistic regression. Findings indicated measurable caregiver burden in 2 of the 5 Caregiver Reaction Assessment (CRA) subscales: impact on schedule and impact on health. Findings also indicated a measurable protective effect of high socioeconomic status of caregivers and the CRA subscale of impact on finances, and a possible protective effect of caregiver self-esteem as measured by the CRA subscale and emergency room utilization within the first 30 days after enhanced recovery surgery. Social change implications include improving the surgical experience of patients and caregivers and enhancing the use of health care resources. Caregiver Burden and Emergency Room Utilization for Enhanced Recovery Surgery Cancer Patients by Mindy Sovel MS, Walden University, 2008 BA, Lehigh University, 1991 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Community Health Education Walden University February 2017 Dedication The role of a caregiver can be all encompassing and difficult to navigate. This work is dedicated to all caregivers, and especially to Sandra Risack Sovel, who was the inspiration for my topic. She has played the role of caregiver many times over to parents, spouse and children with a never ending display of time, effort and support. Mom, you should know that your tireless energy is invaluable (even if we complain about it)! This work is also dedicated to my father, Charles Sovel. Dad, I am sorry you are not here to share in my accomplishment but have relied on your “never give up” attitude to get me to this point on my educational journey. I know how proud you would be. Acknowledgments There are many people that I would like to thank for their support during this process. In the adage “it takes a village”, I would never have completed this program without my village. To my family and friends, I promise to never utter the phrase “I can’t, I have school work” ever again (though I do know some of you have bets on that). It has been a long road and I truly appreciate the support and ear when I needed them. Dr. Palmer, thank you for pushing me and hanging in with me through the starts and stops. Without you setting early goals for me I would still be working on my literature review. My final product is so much more than I expected it to be at the beginning of this process. Dr. Oestmann and Dr. Nasr, thank you for your input over the years and supporting me in this journey. Dr. Leitao and Dr. Laudone, thank you for listening to my research ideas and opening your clinics to enroll patients and caregivers. Without your support this project would never have gotten off the ground. I learned invaluable lessons about being a principle investigator through this study. And Jean Jordan, there are no words to accurately capture your impact, as I may not have enrolled in the doctoral program without your encouragement and there were times when I almost gave up, you gave me the ability to take the next step.