Anxiety,depression and quality of life in family caregivers of palliative cancer patients during home care and after the patient's death

We examined psychological parameters in family caregivers of palliative cancer patients before and after the death of the patients. Caregivers’ data about depression and anxiety (Hospital Anxiety and Depression Scale), quality‐of‐life (Short Form‐8 Health Survey), and social support (Oslo Social Support Scale) were collected at the beginning of home care (t1) and 2 months after the patient had died (t2). Regression models were employed to examine factors related to depression and anxiety in the bereaved caregivers. We interviewed 72 relatives, who were the primary caregiver of a patient. One‐third (31.9%) of caregivers had high anxiety levels and 29.2% had high depression levels (t1, cut‐off = 10). At t2, anxiety and depression had decreased significantly. There were no changes in quality‐of‐life over time. At both points of assessments, quality‐of‐life was lower than in the general population. Relevant factors for higher anxiety and depression in the bereaved caregivers were high levels of distress at t1, insufficient social support and low physical function. Bereaved caregivers were particularly depressed when they had been the spouse of the patient. Healthcare professionals should consider social isolation of caring relatives both during homecare and afterwards. Thus, it seems to be important to routinely offer support to spouses.     

Impact of cancer patients' disease awareness on their family members' health‐related quality of life: a cross‐sectional survey

Background: Conflicting results exist concerning disease knowledge and patients' quality of life (QOL) while there is very limited information concerning the impact of awareness on caregivers' health‐related quality of life. The aim of this study was to explore the influence of disease awareness on both cancer patients and their caregivers during the period of chemotherapy. Materials and Methods: Two hundred and twelve cancer patient–caregiver dyads completed the QOL SF‐36 instrument on the day of chemotherapy. Hierarchical multiple linear regression analysis was performed. Results: Physical component parameters were significantly higher in the family members (p<0.001), while their mental component was lower than cancer patients. Younger patients, females, and of higher educational status were more frequently aware of their disease status while patients with gastrointestinal cancer were more likely to be unaware. Disease knowledge seems to exert a negative influence on patients' physical and mental parameters while lack of awareness affects adversely caregivers' vitality, social function, emotional role, and mental health. Multiple regression analysis confirmed disease awareness affected reversely patients' and caregivers' mental QOL while the counter‐influence of the dyad was revealed. Conclusions: A holistic approach to cancer management should be followed. Patient's treatment is the major medical concern, but health system and professionals should be involved in the mental and physical support of caregivers as well. Tailored interventions that focus on the support of the dyad patient–caregiver should be developed. Copyright © 2010 John Wiley & Sons, Ltd.     

Relationships between supportive care needs and perceived burden in breast cancer survivor–caregiver dyads

While burden in cancer caregivers is high and associated with poor outcomes, little is known about significance of specific supportive care needs’ domains in determining survivors’ or caregivers’ perceived caregiver burden. This cross‐sectional study explored which domains of survivor‐ and caregiver‐reported supportive care needs were most associated with survivor‐ and caregiver‐reported caregiver burden, in breast cancer survivor–caregiver dyads. Cancer survivors (N = 55) and their caregivers (N = 44) completed measures of supportive care needs, anxiety, depression, functional well‐being and perceived caregiver burden. Correlation and linear regression analyses were used to determine relative significance of survivor and caregiver supportive care needs in accounting for variance in survivor and caregiver perceptions of burden. Higher survivor‐perceived caregiver burden and higher caregiver‐perceived difficulty of caregiving were associated with higher levels of survivor and caregiver supportive care needs. Survivors’ psychological needs uniquely contributed to survivors’ self‐perceived burden, and survivors’ sexual needs and caregivers’ work and social needs uniquely contributed to caregivers’ perceived difficulty of caregiving. Caregiver's perceived time spent caregiving was associated with access to services needs but not other needs. Survivor and caregiver supportive care needs and burden appear interdependent. Longitudinal research with larger samples is warranted to examine these relationships.     

Comparison of patient and family assessments of quality of life of terminally ill cancer patients in Japan

Objective: This study examined the extent and the nature of agreement on health‐related quality of life (QOL) assessments between terminally ill cancer patients and their primary family caregivers in Japan, using a multidimensional QOL instrument including psychosocial and spiritual domains. Methods: The Functional Assessment of Chronic Illness Therapy‐Spiritual well‐being questionnaire was used to assess patients' QOL. Study subjects were inpatients of a palliative care unit (PCU), outpatients who applied for admission to the PCU, and their primary family caregivers. Results: QOL ratings were obtained from 102 of 197 eligible patient–caregiver dyads. A moderate level of patient–family concordance on patients' overall QOL as well as families' underestimation of patients' QOL were observed. Families reported on observable domains of patients' QOL more reliably and assessed subjective aspects, such as psychospiritual concerns less accurately. Families tended to underrate the patients' social aspect of QOL, whereas most patients gave the highest rating on support from their families. The spiritual domain, particularly regarding faith, showed the least agreement. The size of the systematic bias between patient and family assessments on the patients' QOL was moderate (>0.50). Conclusions: Families' limited ability to assess psychosocial and spiritual aspects of patients' QOL may suggest the need for better approaches or measures to assess these aspects of a patient's life. The systematic bias was larger than in earlier studies. Further investigation is needed to identify factors affecting patient–family discord on QOL assessments to guide effective interventions to enhance patient–caregiver agreement. Copyright © 2010 John Wiley & Sons, Ltd.     

Depressive symptoms in lung cancer patients and their family caregivers and the influence of family environment

Objective: This study investigated depressive symptomatology in lung cancer patients and their identified caregiver. Methods: We conducted semi‐structured interviews and administered measures of family environment, depressive symptomatology, and the extent to which the caregiver blamed the cancer on the patient not having taken better care of him/herself to 190 patient–caregiver dyads. Multivariate two‐level models were used to estimate the unique effects for each dyad member and cross‐partner effects while controlling for interdependencies in the data. Results: More than half the patients (55%) were male, whereas 74% of caregivers were female. The majority (57.4%) were spouses, followed by offspring, and other family or friends. The baseline model with covariates showed that younger caregivers, spouse caregivers, and caregivers who blamed the patient for the cancer had higher depressive symptom scores. When examining the unique effect for each dyad member, with the exception of patient report of familial conflict, patient and caregiver reports of lower familial cohesion and expressiveness and higher conflict were associated with higher depression scores for patient and caregiver, respectively. When examining cross‐partner effects, patient reports of lower cohesion, lower expressiveness, and greater conflict were associated with higher caregiver depression scores. Offspring caregivers reported less depression than non‐offspring caregivers. Conclusion: The family environment and blaming the patient during times of illness can affect both patient and caregiver depression. Findings suggest that quality of the family dynamic is important for patients, but may be particularly influential for caregivers. Future research should aid clinicians' assessment of family environment when making treatment plans. Copyright © 2010 John Wiley & Sons, Ltd.     

Family resilience and psychological well‐being among Chinese breast cancer survivors and their caregivers

Walsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience and psychological well‐being among Chinese breast cancer survivors and their caregivers. Therefore, this study aimed to examine the direct and indirect relationships between family resilience, breast cancer survivors' post‐traumatic growth (PTG), quality of life (QOL), and their principal caregivers' caregiver burden. A total of 108 breast cancer survivors/principal caregivers pairs completed a cross‐sectional questionnaire survey in a comprehensive cancer of a public hospital in Shandong Province, China. The structural equation modelling (SEM) results showed that family resilience had direct and indirect effects on QOL and caregiver burden, and it was positively related to the PTG of the survivors. The survivors' PTG was positively related to their QOL, and their QOL was negatively associated with caregiver burden. Therefore, a better understanding of how family resilience contributes to PTG and QOL of the survivors and caregiver burden could help clinicians tailor interventions to enhance interventions aimed at improving both survivors' and caregivers' well‐being.     

Contextual and stress process factors associated with head and neck cancer caregivers’ physical and psychological well‐being

Head and neck cancer (HNC) caregivers are especially vulnerable to poor outcomes because the HNC patients are at high risk for physical and functional impairments. This study examines contextual and stress process variables potentially associated with HNC caregivers’ physical and psychological well‐being. Patient‐caregiver variables included socio‐demographics, primary stressors (caregiving, patient clinical characteristics, HNC‐related symptoms/dysfunction), secondary stressors (caregiver employment, childcare responsibilities and sleep duration <7 hr), appraisal, and response (physical activity). General linear models modeled caregiver well‐being, along with depression and anxiety. A total of 33 patient‐caregiver dyads were included. Most caregivers were female (81.8%) and patient spouses/partners (72.7%). Factors significantly associated with better caregiver physical well‐being included caregiver older age, <2 comorbidities, ≥7 hr of sleep, ≥3 days/week physical activity, and patient swallowing and speech dysfunction. Factors significantly associated with better caregiver mental health functioning were less patient social dysfunction and less perceived caregiving burden. Short nighttime sleep, higher caregiver burden, and <3 days/week physical activity were also significantly related to caregivers’ depression and anxiety. Results suggested caregiver behaviors and perceived burden, along with patient HNC concerns are linked with caregiver well‐being. These behavioral, cognitive, and patient factors should be incorporated into caregiver screening tools or targeted with behavioral interventions to improve caregiver well‐being.     

Family caregivers’ perspectives on communication with cancer care providers

Abstract

Purpose/Objectives: Family caregivers of individuals living with cancer are often highly involved in communication with healthcare teams, yet little is known about their experiences, needs, and preferences in this role. To address this gap in the knowledge base, researchers sought to explore family caregivers’ perspectives on communication with oncology care providers.

Design and Methods: Researchers conducted a secondary inductive thematic analysis of qualitative interviews originally collected as part of a randomized clinical trial of a supportive intervention for family caregivers of patients with cancer (N?=?63).

Participants: Participants were family caregivers of adult patients with cancer. Most were patients’ spouses/long-term partners (52.3%) or adult children/grandchildren (29.2%). Caregivers of patients with all cancer types and stages of disease progression were eligible for study enrollment.

Findings: Caregivers valued communication with healthcare providers who were attentive, genuine, broadly focused on patients and caregivers’ experiences, sensitive to unmet information needs, and responsive to the potentially different communication preferences of patients and caregivers.

Interpretation: Family caregivers expressed a strong preference for person-centered communication, conceptualized as communication that helps healthcare providers meet the needs of patients and caregivers both as individuals and as an interdependent unit of care, and that acknowledges individuals’ experiences beyond their prescribed roles of “cancer patient” and “caregiver.”

Implications for Psychosocial Oncology Practice: Psychosocial oncology providers’ strong orientation to the biopsychosocial and spiritual aspects of cancer care delivery make them uniquely positioned to support family caregivers. Findings suggest that providers should explicitly communicate their commitment to both patient and family care, involve family caregivers in psychosocial assessment activities and subsequent intervention, and strive to honor patients and caregivers’ potentially different communication preferences.     

Patient awareness of prognosis, patient-family caregiver congruence on the preferred place of death, and caregiving burden of families contribute to the quality of life for terminally ill cancer patients in Taiwan

Objectives: The main goal of end‐of‐life care is to achieve the best quality of life (QOL) for patients. The purpose of this study was to investigate the impact of (1) the patients' awareness of their prognosis, (2) the extent of patient–family caregiver congruence on the preferences for end‐of‐life care options, and (3) the perceived caregiving burden of family caregivers when they provide end‐of‐life care to their dying relative, on the QOL for terminally ill cancer patients in Taiwan. Methods: A total of 1108 dyads of patient–family caregiver from 24 hospitals throughout Taiwan were one‐time surveyed. Predictors of the QOL were identified by multiple regression analysis. Results: Controlling for the effects of age, financial status, and symptom distress, a novel finding of this study was that the patient awareness of prognosis, patient–family caregiver congruence on the preferred place of death, and the subjective family caregiving burden had a significant impact on the QOL of Taiwanese terminally ill cancer patients. Conclusions: QOL is not only related to the unavoidable decline in physical condition and daily functioning of the dying patient but is also related to domains that, as death approaches, have the potential to show improvement through the efforts of health‐care professionals, such as presenting prognostic information to optimize the patients' understanding and assists them with psychological adjustments, facilitating patient–family caregiver congruence on the end‐of‐life care decision regarding the place of death and lightening the caregiving burden of family caregivers. Copyright © 2008 John Wiley & Sons, Ltd.     

Doctor-Patient Cancer Screening Communications among Church-based Chinese Adults – The Role of Caregiver Experience and Family History

Objective: Significant gap exists in the literature examining cancer screening communication related factors among Chinese immigrants.  This study examined the role of cancer caregiver experience and family history on doctor-patient cancer screening communication among church-based Chinese adults. Methods: A self-administered survey was conducted among adults from 9 Chinese churches (n=372). Cancer Communication was measured by “Dr. recommended screenings” and “Talked to doctors about cancer screenings”. The survey was developed in English and translated in Chinese. Results: Mean age was 44.31 (SD=14.74), 60% were males, 72% were married, majority had college education (85%), and 17% reported had been a primary cancer caregiver and 54% reported having family cancer history. Cancer caregivers scored higher on doctor-patient cancer communication, as well as cancer knowledge and screening norms.  Participants with family cancer history were also more likely to talk to doctor about screening, as well as perceived higher cancer risk, lower health status, and screening barriers. Multiple regression analyses showed that primary caregiver experience was still a significant predictor on talking to doctors about cancer screenings (OR=2.1; 95%CI=[1.10, 4.01]; p=0.025), yet doctors more like to recommend screening among caregivers became non-significant.  The significant influence of family cancer history on talking with doctors on cancer screenings also disappeared.  Older age (OR=2.52; p=0.006) and being married (OR=2.45; p=0.022) were significant on predicting communication of cancer screenings with doctors. Data also showed that doctors were more likely to recommend cancer screenings to older (OR=2.75, p <.001), married (OR=2.57; p=0.006) adults. Conclusion: Current study calls attentions to primary cancer caregiver experience, family history, age, and marital factors when designing tailored doctor-patient cancer screening communication programs among church-based Chinese to address cancer disparities.     

End-of-life care in Italy: personal experience of family caregivers. A content analysis of open questions from the Italian Survey of the Dying of Cancer (ISDOC)

Objective: This study aims at describing the emotional and practical experience of a representative sample of Italian non‐professional caregivers when caring for a terminally ill family member and is part of the ‘Italian Survey of the Dying of Cancer’, which involved 2000 adult cancer deaths representative of the whole country. Methods: Information on patients' experience was gathered from non‐professional caregivers by an interview. A specific question was asked about the caregivers' emotional and practical experiences while assisting a terminally ill relative. A content analysis of the open question on caregivers' perceptions was performed on transcribed answers. Three researchers independently generated categories. Subsequently, areas where they differed were reconsidered and an interpretation was agreed upon. Results: Valid interviews were obtained from 1231 non‐professional caregivers. Answers were classified according to the perception of the experience as positive (33.1%), negative (65.1%) or neutral (1.8%). Conclusion: Assisting a family member with cancer in his/her last three months of life is a very strong physical and mental stress for the caregiver. In some cases, this experience is nevertheless perceived as an evolution chance. Health‐care providers should need to develop programs to ensure that family caregivers' needs for information and support are given great importance. Copyright © 2008 John Wiley & Sons, Ltd.     

Psychometric evaluation of the German Version of the Supportive Care Needs Survey for Partners and Caregivers (SCNS‐P&C‐G) of cancer patients

This study aimed for psychometric validation of the German version of the Supportive Care Needs Survey for Partners and Caregivers (SCNS‐P&C‐G). In‐ and outpatients with lung, urological and gastrointestinal cancer at Heidelberg University Hospital in Germany and in each case one relevant caregiver were asked to complete a set of questionnaires assessing their unmet needs together with distress, depression, anxiety and caregiver strain. In addition, medical data of the patients were collected. Fully completed questionnaires were received from 188 pairs of patients and their caregivers. Using exploratory factor analysis, four domains of unmet needs were identified with an appropriate variance explanation (58.7%) and acceptable (>0.70) internal consistencies (α = 0.95 to 0.76) for each domain. Convergent validity was found with respect to significant positive correlations (>0.40) of the SCNS‐P&C‐G domains with caregivers’ anxiety, depression and strain. Although poorer health status of the patient indicated more unmet caregiver needs, this finding was not consistent for all need domains. Overall, associations were only moderate to weak pointing out the necessity of a separate screening for caregivers’ needs. The findings of this study support that the SCNS‐P&C‐G is an appropriate research instrument to assess caregivers’ needs on different domains throughout the disease trajectory.     

Quality of life in a heterogeneous sample of caregivers of cancer patients: an in‐depth interview study

MANCINI J., BAUMSTARCK‐BARRAU K., SIMEONI M.‐C., GROB J.‐J., MICHEL G., TARPIN C., LOUNDOU A.‐D., LAMBERT A., CLÉMENT A. & AUQUIER P. (2010) European Journal of Cancer Care
Quality of life in a heterogeneous sample of caregivers of cancer patients: an in‐depth interview study To establish the best approach to develop a quality of life (QoL) questionnaire for cancer‐patient caregivers, this study attempts to identify primary domains of QoL in terms of their impact on a purposive sample of caregivers. Seventy‐seven informal adult caregivers of cancer patients (breast cancer, paediatric haematological malignancies or melanoma) with different relationships with the patients (parents, children, spouses, siblings, and friends) were recruited at three specialised French centres and extensively interviewed. Caregivers' lives were altered in several domains: psychological well‐being, leisure and everyday activities, relationships with institutional caregivers, occupation and finances, relationships with family and friends, physical well‐being, and relationship with the patient. The relative importance of these domains varied mainly in association with the caregiver‐patient relationship. Multiple correspondence analysis identified two isolated clusters: children, and, most significantly, friends and siblings. The latter groups emphasised the repercussions on their psychological well‐being and their relationship with the patient, but were less willing to discuss the impact on their relationship with caregivers and on occupation, finances, leisure, and everyday activities. This study focuses on the caregiver's perspective and advocates the development of a short QoL core questionnaire. Additional modules should be cancer‐specific or dedicated to specifics of the caregiver‐patient relationship.     

常见脑肿瘤住院患者主要照顾者负担的影响因素

目的：探讨分析影响常见脑肿瘤住院患者主要照顾者的负担影响因素,以期在一定程度上能够针对性的帮助主要照顾者减轻其负担。方法：采用调查问卷的形式开展调查,问卷的内容包括一般资料调查、照顾者负担量表以及症状自评量表（SCL -90）。结果：用负担量表评价脑肿瘤住院患者主要照顾者的负担情况,其中负担最重的是时间依赖,接下来依次为身体负担和情感负担。脑肿瘤患者的主要照顾者在躯体化、抑郁、焦虑、恐怖、偏执、焦虑等六个方面对比常模组有显著性差异。而人际关系敏感度、敌对和精神病性等三个方面对比则没有统计学差异。影响脑肿瘤住院患者主要照顾者负担的影响有患者因素、是否有共同照顾者、照顾持续时间、患者医疗费用支付方法及照顾者的心理状态。结论：肿瘤患者的身心状况是影响肿瘤患者照顾者生活质量的主要因素。     

Burden,emotional distress and quality of life among informal caregivers of lung cancer patients: An exploratory study

This study was conducted to explore the interrelationships among caregiver burden, emotional status and quality of life (QoL) in caregivers of lung cancer patients, and to identify whether caregiver burden and health status are associated with patient emotional status and QoL. Forty‐three dyads of lung cancer patients and their caregivers were included for analysis. Caregiver‐reported outcomes were measured by Caregiver Burden Scale (CBS), Caregivers Quality of Life Index‐Cancer (CQOLC) and Hospital Anxiety and Depression Scale (HADS), while patient‐reported outcomes were collected by HADS and Lung Cancer Symptom Scale (LCSS). The majority of the CBS and CQOLC scores were significantly higher in anxious and depressed caregivers than non‐anxious and non‐depressed caregivers (p < .01 or .05). Caregivers of depressed patients experienced significantly greater emotional distress than those of non‐depressed patients (p < .01). Significantly positive associations were identified among most of the CBS, CQOLC and caregiver HADS scores. Patient LCSS scores were positively correlated with the CBS and caregiver HADS scores, and patient HADS scores were also positively related to caregiver HADS scores. The close interrelationships between caregiver and patient health outcomes provide evidence that lung cancer patients and their caregivers should be viewed as a unit in future supportive service models.     

The development of a comprehensive needs assessment tool for cancer-caregivers in patient-caregiver dyads

Objective: The assessment of a caregiver's needs is a critical step for determining appropriate support services, providing high quality care, and achieving caregiver satisfaction. However, a systematic assessment of family caregiver's needs is rarely practiced. This study reports the development and validation of a comprehensive needs assessment tool for cancer caregivers (CNAT‐C). Methods: Items of CNAT‐C were generated through literature review and refined through expert consultation and caregiver interview, and pilot test. Final 41‐item needs assessment tool for cancer was developed and validated in a large‐scale multi‐center survey involving 600 cancer patients‐family caregiver dyads in 10 cancer centers fairly distributed throughout Korea. Results: The content validity of CNAT‐C was established throughout the development process. Principal component analysis resulted in a seven‐factor structure explaining 66.4% of the total variance: (1) health and psychological problems (6 items), (2) family/social support (5 items), (3) health‐care staff (8 items), (4) information (8 items), (5) religious/spiritual support (2 items), (6) hospital facilities and services (6 items), and (7) practical support (6 items). The Cronbach alpha was 0.96 for the total scale, and those for the subscales ranged from 0.79 to 0.95. Caregiver needs were not highly correlated with patient needs when compared domain‐by‐domain. Known‐group validity was also supported by the tool's ability to detect significant differences according to various patient and caregiver characteristics. Conclusions: The CNAT‐C appears to be a valid and reliable measure to assess comprehensive and multidimensional needs in caregivers of cancer patients. Copyright © 2010 John Wiley & Sons, Ltd.     

Caring for patients with oral cancer in Taiwan: The challenges faced by family caregivers

Family caregivers face multiple challenges when caring for patients with oral cancer at home. Understanding the difficulties they face may assist health professionals to better organise and provide support for family caregivers of oral cancer patients. The aim of this study was to describe the caregivers’ primary tasks and the difficulties they encounter when caring for a family member with oral cancer. This qualitative study included a purposeful sample of 22 primary family caregivers ranging in age from 25 to 71 years old. The researchers used face‐to‐face, semi‐structured and tape‐recorded interviews to collect data and employed qualitative content analysis to elicit caregiving‐related themes. Six task‐related themes and associated challenges were identified. These included managing the patient's nutritional issues, investigating and making decisions about patient care, managing sudden and unpredictable changes in the patient's condition, managing emotional distress, adjusting their attitudes towards patient care, and seeking resources. Family caregivers handle such essential tasks when they care for patients in home settings and they face specific challenges related to them. This study identified several challenges related to each task. From the outset, healthcare providers should actively offer caregiving information and strategies. Health professionals can incorporate strategies for supporting caregivers’ ability to carry out these tasks into their treatment model and can help caregivers manage difficulties that can impede them from doing so.     

Partner Support and Changes in Relationships During Life-Threatening Illness

Abstract

This study aimed to establish the prevalence of psychiatric morbidity among cancer patients' caregivers and to identify markers of risk. Using the Psychiatric Assessment Schedule (a standardized psychiatric interview), the authors assessed 222 caregivers retrospectively. Thirty-one caregivers (14%) had developed an affective disorder during the two years since the patients' initial cancer diagnoses. Caregivers who were the patient's partner were more likely to develop anxiety, depression, or both when their ill spouse had developed these symptoms. Notably, the prevalence of affective disorders among female caregivers was comparable to the prevalence among patients (23%). Female nonpartner caregivers developed disorders as frequently as partners did. Female caregivers with a prior history of affective disorder who reported more illness-related concerns appeared to be at particular risk, providing useful markers for clinical practice.     

Social support buffers the impact of functional impairments on caregiver psychological well‐being in the context of brain tumor and other cancers

Objective: This study investigated the association between functional impairments of individuals with cancer and caregiver psychological well‐being, and examined the moderating effect of social support. Methods: Sixty‐three caregivers (71% female) of individuals with brain tumor (n=27) and other cancers (n=36) were recruited from community services. Caregivers rated their psychological well‐being on the World Health Organisation Quality of Life measure Brief version, social support on a brief version of the Social Support Questionnaire, and the individuals' functional impairments on the Patient Competency Rating Scale. Results: For caregivers of individuals with brain tumor, better psychological well‐being was associated with lower functional impairment in all domains (r_s=0.33–38, p<0.05), except for cognitive difficulties. For caregivers of individuals with other cancers, better psychological well‐being was associated with lower functional impairment in all domains (r_s=0.30–0.49, p<0.05), with the exception of activities of daily living. For the total caregiver sample, better psychological well‐being was significantly correlated with overall functional impairment (r=0.34, p<0.005) and satisfaction with support (r=0.40, p<0.005). Caregivers supporting individuals with greater functional impairment had better psychological well‐being if they were highly satisfied with their social support. Conclusions: Effective social support is particularly important for caregivers who support individuals with poorer functional status, and this study highlights the need to evaluate caregiver social support interventions in the context of cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF): a new measure

Objectives: Caregivers and cancer patients frequently have conflicting and unmet communication needs. The Cancer Communication Assessment Tool for Patients and Families (CCAT‐PF) is a new instrument that assesses congruence in patient–family caregiver communication for both research and clinical purposes. Methods: The scale was developed using a sample of 190 lung cancer patient–caregiver pairs. Standard psychometric procedures were used to develop and test the scale including qualitative item pool development, item reduction and ascertainment of scale properties. Results: The multiple correlation of the 18‐item CCAT‐PF scale with the longer 30‐item scale was 0.94. All but three items had less than 20% variance accounted for when each item was regressed on the remaining 17, indicating that responses to an individual item were not readily predicted by the remaining items. Test re‐test reliability was 0.35 and Cronbach's alpha was 0.49 as the CCAT‐PF scale represents the sum of mostly independent items. Higher CCAT‐PF scores were significantly correlated with greater patient depression, greater patient perceived family conflict, lower patient–caregiver assessment and well‐being and less expressiveness and family cohesion. For both patients and caregivers, physical, functional and emotional well‐being were not associated with CCAT‐PF scores. Conclusion: The CCAT‐PF is a brief but reliable and valid tool. Although administering both family and patient versions is optimal, administering it to a patient or family caregiver only also produces reliable information. Copyright © 2008 John Wiley Sons, Ltd.