Self-perceived needs of primary caregivers of home-hospice clients

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.

Spouse cancer caregivers' burden and distress at entry to home hospice: The role of relationship quality

High-quality relationships may be protective for family caregivers. This study focuses on relationship quality categories (supportive and ambivalent) in spouse caregivers in cancer home hospice. The goals of this article are to, first, describe relationship quality categories among end-of-life caregivers and, second, test the effects of relationship quality categories on caregiver burden and distress within a stress process model. Using questionnaire data collected at entry to home hospice, we found relationship quality categories were proportionally similar to those seen in noncaregiver older adults. Relationship quality significantly predicted caregiver burden, which completely mediated the relationship between caregiver relationship quality and distress. Caregivers whose social contexts place them at risk for greater distress may benefit from increased clinical attention or intervention.

Home-based palliative care: a systematic literature review of the self-reported unmet needs of patients and carers

BACKGROUND

There have been many studies on the unmet needs of palliative care patients and carers from the perspective of bereaved caregivers. However, the unmet needs of palliative care patients and carers from the perspective of current patients and their carers have received little research attention.

AIM

As home-based services have become one of the main delivery models of palliative care, the aim of this review was to describe, evaluate and summarise the literature on the unmet needs of palliative home care patients and carers.

DESIGN

The systematic review of qualitative and quantitative studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

PubMed, CINAHL, Embase, MEDLINE, PsycINFO, AMED and CareSearch were searched to find empirical studies on the self-reported unmet needs of palliative home care patients and carers.

RESULTS

Nine qualitative studies, three quantitative studies and three mixed-design studies were identified. The most frequently reported unmet need was effective communication with health-care professionals, the lack of which negatively impacted on the care received by patients and carers. Physical care needs were met, which indicates that the examined palliative home care services were delivering satisfactory care in this domain, but lacking in other areas.

CONCLUSIONS

The focus therefore should be on improving other aspects of patient care, including communication by health professionals to prevent or reduce suffering in areas such as psychosocial domains. Valid and reliable quantitative measures of unmet needs in palliative care are needed to examine this area more rigorously.

The hospice caregiver support project: providing support to reduce caregiver stress

INTRODUCTION

The vast majority (80%) of care provided to hospice patients is given by informal and unpaid caregivers, who are often family members. They may be responsible for everything from management of the household and finances to medical and personal care. Providing this kind of care to a loved one at the end of life can contribute to increased stress, health problems, and decreased quality of life.

METHODS

Hospice social workers referred caregivers identified as needing additional support into a special project that funded services not covered by hospice and that the family could not afford to purchase. There were no restrictions on the types of services that could be requested. The Pearlin role overload measure (ROM) was administered and the family selected a service provider from an approved list of agencies. Upon completion of the service period, the ROM was re-administered. Use of the hospice respite benefit by any hospice patient during this study was compared with use before the project began.

RESULTS

Self-reported caregiver stress, as measured by the Pearlin ROM pre- and post-services, decreased by 52% (t(122) = 10.254; p < 0.0001). Use of the hospice respite benefit requested by any hospice patient caregiver decreased during the project period (χ(2), p < 0.02), and when respite was requested fewer days were used as compared with the same time period prior to the project (χ(2), p < 0.0043).

CONCLUSION

The project results show that offering such services relieved caregiver stress, reduced use of respite, and reduced the number of respite days used.

Stressors in five client populations: Neuman systems model-based literature review

AIM

This paper reports a literature review identifying and categorizing client system stressors in Neuman systems model-based studies.

BACKGROUND

To date, literature reviews related to the Neuman systems model have focused broadly on all concepts of the model. The concept of stressors has been selected by the Neuman Systems Model Research Institute as the focus for an initial collaborative research project.

METHOD

Cooper's five-stage integrative review method was used: problem formulation, data collection, data evaluation, analysis and interpretation, and dissemination. The Neuman systems model research literature from 1983 to February 2005 was searched using Fawcett's Neuman systems model bibliography and a follow-up review of the CINAHL database using the keywords 'Neuman systems model' and 'stressors'. A total of 87 studies published as journal articles or book chapters between 1983 and 2005 were reviewed; 13 of the 87 studies met the definition of 'stressor studies'.

FINDINGS

Stressors were identified in five client populations: caregivers, cancer survivors, ICU patients in intensive care units, care receivers, and parents whose children were undergoing day surgery. The most common data collection method was the interview, and investigator-developed interview guides were most often used. Evidence of categorization of intra-, inter- and extra-personal stressors was present. The following overall stressors were identified: burden of responsibility (caregivers); awareness of vulnerability (cancer survivors); being overwhelmed (patients in intensive care units); loss of control (parents); and frustration with role changes (care receivers).

CONCLUSIONS

These data could form the basis for nursing practice as well as future research within a collaborative environment. Given the existing body of knowledge concerning Neuman system model-derived middle range theory concepts in the caregiver population, the middle-range theory of caregiver role strain could be tested empirically.

A conceptual model and key variables for guiding supportive interventions for family caregivers of people receiving palliative care

According to the World Health Organization, the patient and family should be viewed as the "unit of care" when palliative care is required. Therefore family caregivers should receive optimal supportive care from health professionals. However, the impact of supporting a dying relative is frequently described as having negative physical and psychosocial sequalae. Furthermore, family caregivers consistently report unmet needs and there has been a dearth of rigorous supportive interventions published. In addition, comprehensive conceptual frameworks to navigate the family caregiver experience and guide intervention development are lacking. This article draws on Lazarus and Folkman's seminal work on the transactional stress and coping framework to present a conceptual model specific to family caregivers of patients receiving palliative care. A comprehensive account of key variables to aid understanding of the family caregiver experience and intervention design is provided.

Care for the caregivers: a review of self-report instruments developed to measure the burden, needs, and quality of life of informal caregivers

Significant demands are being placed on the informal caregivers of chronically ill patients, including those suffering from cancer. Health care professionals need to be aware of these demands, and they need effective tools to assess the impact these demands place on the caregivers. Over the past 25 years, researchers have developed self-report instruments to assess informal caregivers. These instruments assess various aspects of the caregiving experience, including caregiver burden, needs, and quality of life. The purpose of this review was to identify and critically evaluate these instruments. MEDLINE and PUBMED were searched from 1966 to 2002. After an extensive literature search and review, and utilizing specific inclusion criteria, 28 instruments were identified and evaluated in terms of their development, content, and psychometric properties. In addition, a history of the construct and measurement development in the areas of caregiver burden, needs, and quality of life are discussed. Although some further development and refinement of instruments could benefit the field, depending on the questions researchers or clinicians seek to pursue, there are many proven tools available for their use. Future research needs to use these instruments to assess the effectiveness of interventions aimed at improving the care of the caregivers.

Barriers to accessing hospice services before a late terminal stage

Although hospice care has been available in the United States for over 25 years, the trend of late terminal access persists. Quality assessments and interventions that will continue through a year of bereavement are based on early interactions and the formation of caring and trusting bonds. A qualitative research study was conducted to identify and describe barriers to timely access as perceived by those involved in hospice care: caregivers, hospice staff and volunteers, and referring physicians. Major findings include persistent knowledge deficits including misconceptions and lack of awareness of components and skill associated with hospice care: reluctance to disclose, discuss, or acknowledge patient terminality, and access of hospice care being perceived as giving up on the patient.

Health practices of adults with elder care responsibilities

BACKGROUND

This study examined health-risk behaviors and preventive health care activities among caregivers for older adults.

METHODS

Survey questionnaires regarding health practices were completed by 272 caregivers and 917 noncaregivers selected through a stratified random sample of persons age 50 or older who were members of the Kaiser Foundation Health Plan in Northern California.

RESULTS

Controlling for age, gender, race, education, marital status, and income level, caregivers were more likely than noncaregivers to eat breakfast daily, get flu shots, and receive pneumonia vaccines. Caregivers and noncaregivers did not differ significantly with regard to any of 10 other health practices or to the total number of positive health behaviors. Poorer health practices were associated with nonwhite racial identification, low income level, part-time employment, and health limitations.

CONCLUSIONS

These findings suggest that, at least for caregivers who have access to the extensive health promotion resources of a large health maintenance organization, caregiving responsibilities may not always have the deleterious impact on health and health practices that had previously been assumed.

Identifying the responsibilities & needs of working adults who are primary caregivers

1. Caregivers of the elderly are mostly married women caring for mothers by completing household chores and personal care, managing finances and providing financial support, transportation, and companionship. 2. Caregivers attribute a variety of health care problems related to the burden of caregiving and miss an average of 8 days of work a year related to caregiving responsibilities. 3. The majority of caregivers express ten educational needs that would be helpful in their caregiving activities.