Intravenous considerations

Predicting Family Caregiver Psychosocial Functioning in Palliative Care

Background

Health professionals are expected to support family caregivers of patients requiring palliative care. However, there is a dearth of empirical evidence to help clinicians identify caregivers who might be at risk of poor psychosocial functioning.

Purpose

This secondary analysis of baseline data from a larger study sought to determine if it was possible to predict the psychosocial functioning of family caregivers who were supporting a relative with advanced incurable cancer.

Method

Data from 35 primary family caregivers obtained at the start of home-based palliative care services and five weeks later was used in the analysis. Instruments to measure caregiver preparedness, competence, mastery, social support, anxiety, and self-efficacy were used.

Results

Cluster and logistic analyses revealed that self-reported “anxiety” and “competence” subscale total scores at time of commencement of home-based palliative care services were associated with caregivers at risk of lower levels of psychosocial functioning five weeks later.

Conclusions

This study suggests that it may be possible to identify family caregivers who are at risk for poorer psychosocial functioning. However, replication in a larger sample is required before this screening approach can be recommended for clinical use.

Psychosocial Interventions for Patients With Advanced Cancer and Their Families

Few randomized controlled trials of family-based psychosocial interventions involving patients and at least one other family member have been conducted in the context of advanced cancer. Moreover, existing interventions have largely been stand-alone programs that have not been well integrated into routine palliative and clinical care. Programs that address this gap may not only improve patient and caregiver quality of life (QOL) but also the quality of palliative and supportive care services. The aim of this narrative review is to describe published interventions that have attempted to improve the QOL of advanced cancer patients and their family caregivers (eg, spouses, partners, and other family members) and to describe some of the challenges that make it difficult to implement such programs in clinical settings. Toward that end, the added value that family-based psychosocial interventions can bring to advanced cancer care is first described. Next, the literature on family-based interventions in advanced cancer is reviewed, and different theoretical approaches and outcomes are highlighted. This is followed by a description of some of the health system barriers to supportive family care in advanced cancer care. The article concludes with a synthesis of research findings and proposes directions for future research.

Loss of appetite: a poetic exploration of cancer patients’ and their carers’ experiences

AIM

To explore the experience of loss of appetite among palliative care cancer patients and their carers supported by a specialist palliative care team in the community.

METHOD

Semistructured interviews were conducted with seven palliative care cancer patients and their carers in the community. A poetic transcription of participants' words was made to capture and communicate the essence of each person's experience before the thematic analysis was undertaken.

FINDINGS

Six common themes emerged from the data: a fickle phenomenon; the cost of caring; facing uncertainty and death; adaptations; accepting limitations; and what patients want: 'listen to me'. These were illustrated by the poetic transcriptions.

CONCLUSION

Meeting the differing needs of palliative care patients with loss of appetite and their carers is challenging. It demands a thorough assessment of symptoms, an understanding of the underlying pathophysiology and of the role food plays in society. An understanding of the experience of loss of appetite is essential to the provision of appropriate care and support to those affected by it. The study demonstrated that, although unusual, poetic transcriptions can be an effective method of presenting data in terms of acceptability to participants and communicating their experience to others.

Meeting the supportive needs of family caregivers in palliative care: challenges for health professionals

Caring for a dying relative is demanding, and family caregivers have acknowledged many unmet needs associated with their caregiver role. Consistently, caregivers of dying patients with cancer have reported that they need more support and information from health care professionals. Moreover, a number of palliative care clinicians and researchers have called for interventions to enhance the support offered to family caregivers. However, before researchers can develop and test palliative care interventions directed to families, it is important to identify barriers that may confront health care professionals with regard to the provision of supportive family care. For new interventions to be feasible they must be applicable within the constraints of current palliative care service delivery environments. This paper provides an account of issues that may impinge on optimal transference of supportive strategies from health care professionals to family caregivers of patients receiving palliative care. By acknowledging these barriers to supportive care, researchers and health care professionals can begin to design and implement interventions that are clinically relevant and more likely to be effective.

Palliative care provision and its impact on psychological morbidity in cancer patients

In response to many influences, palliative care services in the UK are evolving rapidly, and are increasingly challenged to demonstrate equity, access and effectiveness. This article discusses the principles, philosophy and status of palliative care in the UK in the context of recent NHS developments. A case study is employed in order to critically evaluate the implementation of the palliative care approach, focusing on the specific issue of the assessment of anxiety and depression in the cancer setting. The provision of a comprehensive and integrated clinical service is a constant challenge in this patient group. In order to increase awareness and facilitate further development of patient services, and ultimately improve clinical practice, several factors are highlighted. These include the impact of multiprofessional team care, the problems inherent in the diagnosis of depression and the question of whether cancer nurses are adequately prepared to handle patients' psychological morbidity.

Using a model for structured reflection on palliative care nursing: exploring the challenges raised

Reflection on palliative care nursing practice has to encompass every dimension of the holistic care we offer. In this article a possible structured model for reflection on palliative care nursing is discussed and used to reflect on the care given during a community Macmillan nurse visit. The reflection revealed a number of challenges. These included the possible conflict between patient autonomy and quality of life for carers; the role of intuition in palliative nursing and spiritual care. The article concludes that reflection has a role to play in exploring the innate tensions in palliative care, voicing the often silent intuitive knowledge and promoting expertise in spiritual care.