Advanced cancer at home: caregiving and bereavement

BACKGROUND: The advanced and terminal phases of cancer are being increasingly treated at home with the aid of palliative care teams. It is well known that caregivers are overburdened emotionally, financially and physically, and some studies have demonstrated that this overload extends beyond the period of mourning. Identifying caregivers at risk of bereavement maladjustment is a useful means of ensuring prompt psychological and social assistance, and optimising the available resources. METHODS: One hundred and eleven caregivers of home-treated patients with advanced/terminal cancer were recruited by the palliative care unit operating in their place of residence. After giving their informed consent, all of the caregivers were asked to complete questionnaires designed to evaluate various emotional, financial and social aspects. Three, six and 12 months after the decease of their patients, the caregivers were contacted again and asked to complete other questionnaires aimed at assessing their emotional reactions and bereavement-related problems. RESULTS: The 12-month follow-up was completed by 93 caregivers. Their bereavement maladjustment problems correlated with their perception of emotional distress and the caregiving-related problems detected at the time of referral, particularly among females. Spouses, subjects aged over 61 years and those perceiving a substantial emotional burden proved to be at greater long-term risk. CONCLUSIONS: The identification of overburdened caregivers and those at risk of long-term bereavement maladjustment may facilitate the programming of ad hoc interventions that could reduce inherent health and social costs. Palliative care teams can usefully include someone to identify such caregivers by means of inexpensive and objectively predictive instruments.     

Family caregiving in cancer pain management

The experience of cancer pain is known to greatly affect family caregivers as well as patients. There are many demands placed on caregivers of cancer patients with pain at home as a result of the shifting of care from the acute setting to the home. These complex demands significantly affect caregiver quality of life. The purpose of this study was to describe the experience of pain management from the perspective of family caregivers of patients with cancer amidst the current healthcare environment. This quasi-experimental study involved 231 family caregivers of patients with cancer pain receiving home care. Family caregivers were assessed in conjunction with a pain education program that provided patient and. family education regarding pain assessment, drug and nondrug interventions. Assessment measures used were the Quality of Life (QOL)-Family Caregiver Tool, Knowledge and Attitudes about Pain (K&A) Tool, and Caregiver Finances Tool. Study findings reveal disruption to family caregiver quality of life in the areas of physical, psychological, social, and spiritual well-being. There is also a continued need for education regarding cancer pain management. Comparison between patients and family caregivers demonstrates that pain impacts both the patient experiencing it and their caregivers.     

Family caregiving in dementia in Japan

Family caregivers were interviewed to describe their caregiving experience with their older relatives who were afflicted with Alzheimer's disease at home. Three elements were identified to contribute toward a caregiving career: (a) good prior relationships between caregivers and care recipients, (b) positive interpretations of the relative's condition, and (c) utilization of resources. Some caregivers were identified as high risk: husbands caring for their wives and daughters-in-law caring for their mothers-in-law. Specific interventions for these subgroup caregivers are in order.     

Family caregiving skill: development of the concept

Families increasingly are expected to provide complex care at home to ill relatives. Such care requires a level of caregiving knowledge and skill unprecedented among lay persons, yet family caregiving skill has never been formally developed as a concept in nursing. The purpose of the study reported here was to develop the concept of family caregiving skill systematically through qualitative analysis of interviews with patients (n = 30) receiving chemotherapy for cancer and their primary family caregivers (n = 29). Open coding and constant comparison constituted the analytic methods. Sixty-three indicators of caregiving skill were identified for nine core caregiving processes. Family caregiving skill was defined as the ability to engage effectively and smoothly in these nine processes. Properties of family caregiving skill also were identified. Conceptualizing skill as a variable and identifying indicators of varying levels of skill provides a basis for measurement and will allow clinicians to more precisely assess family caregiving skill.     

Family caregiving: application of Newman's and Peplau's theories

The purpose of this paper was to apply Newman's and Peplau's theories in situations where family members assumed the role of the primary caregiver for their relative diagnosed as mentally ill. The commonality between the two theories is the nurse—client relationship. Despite different theoretical underpinnings, both theories were found useful when applied to family caregiving situations. Both theories aim toward the inner growth of the client, which is the goal of psychiatric and mental health nursing.     

Family attitudes about tobacco smoke exposure of young children at home

PURPOSE: To explore families' attitudes about smoking and their perceptions of the effects of environmental tobacco smoke (ETS) exposure on their children. STUDY DESIGN AND METHODS: Qualitative study using face-to-face interviews with a semistructured guide in 20 households containing a child under age 5. Content analysis was done on the interview data. RESULTS: Families identified "health protection" as the parental responsibility for children and emphasized helping children make decisions not to smoke. Some reported negative experiences with ETS exposure as children themselves or health problems in their children, reinforcing their opposition to smoke exposure for their children. Most parents said they did not allow smoking in their homes, but some later disclosed that they made exceptions for family and friends. Some parents, however, limited their children's contact with smoking members of their families. Smoking parents expressed guilt about ETS exposure of their children and tried to limit smoking to certain areas of their houses, such as the basement. Other parents, mostly the nonsmokers, did not identify ETS as a problem. Families who maintained smoke-free households identified that family and friends had to "respect" their wishes. CLINICAL IMPLICATIONS: To protect children from the negative effects of ETS exposure, nurses should discuss not only if parents smoke but also if family members and friends are allowed to smoke in the home. It would be helpful to assess the priority that parents set on ETS and how they attempt to prevent it in their daily lives.     

Family caregivers want education for their caregiving roles.

Societal expectations demand that families provide the greatest share of care for the disabled in this country. Unless the families are prepared for their caregiving jobs, these societal demands are likely to become less viable.     

Correlates of caregiving satisfaction: prerequisites to elder home care

In this comparative study, a path analytic model was used to identify variables predictive of satisfaction in providing care to elderly family members, and to determine differences in the predictor variables between past and present caregivers as potential precipitators of institutionalization. Nineteen current caregivers and 29 past caregivers were recruited from health agencies in a rural area. Demographic predictors of caregiving satisfaction included age and sex of the client and age of the caregiver; psychological problems of the client influenced caregiver satisfaction. Measures of situational stress (medical, psychological, environmental) revealed that the past caregivers had higher psychological and environmental stress and less life satisfaction than current caregivers. Additional analysis revealed that the most common pattern of nursing home admission was hospitalization of the client for physical illness, with subsequent physician-recommended nursing home placement. Areas of identified need for preventing premature relinquishing of the caregiving role are discussed.     

Family structure and mothers' caregiving of children with cystic fibrosis

The purpose of this investigation is to examine differences in the experiences of mothers of children with cystic fibrosis who are in diverse family structures (first-marriage families, stepfamily households, single-parent households). In particular, mothers' perceptions of children's health, adherence to prescribed treatments, and help received from others were compared and predictors of treatment adherence were examined. Children's health and adherence to treatment regimens were not related to family structure. Mothers had the major responsibility for seeing that cystic fibrosis treatments were followed, regardless of family structure. Single mothers received less help than married and repartnered mothers. Married fathers helped with treatments more than nonresidential divorced fathers and stepfathers. Implications for nursing practice and suggestions for future research are offered.