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Impact on caregiver burden of a patient-focused palliative care intervention for patients with advanced cancer

Published online by Cambridge University Press:  28 September 2010

Ross E. O'Hara ,
Jay G. Hull ,
Kathleen D. Lyons ,
Marie Bakitas ,
Mark T. Hegel ,
Zhongze Li  and
Tim A. Ahles
Ross E. O'Hara*
Affiliation:
Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
Jay G. Hull
Affiliation:
Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
Kathleen D. Lyons
Affiliation:
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire
Marie Bakitas
Affiliation:
Department of Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire Section of Palliative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire School of Nursing, Yale University, New Haven, Connecticut
Mark T. Hegel
Affiliation:
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire
Zhongze Li
Affiliation:
Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire
Tim A. Ahles
Affiliation:
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire Department of Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Ross O'Hara, Department of Psychological and Brain Sciences, Hinman Box 6207, Dartmouth College, Hanover, NH 03755. E-mail: ross.ohara@dartmouth.edu
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Abstract

Objective:

Caregivers of patients with advanced cancer experience physical and emotional strain that can raise their own risk for morbidity and mortality. This analysis was performed to determine whether ENABLE II, a patient-focused palliative care intervention that increased patients' quality of life, reduced symptom intensity, and lowered depressed mood compared to usual care, would affect caregiver burden.

Method:

Caregivers of patients with advanced cancer from the parent study completed a caregiver burden scale and patients completed quality of life, symptom intensity, and depressed mood measures. Data were collected at baseline, 1 month, and every 3 months thereafter until patient death or the study ended. Decedents' caregivers were asked to complete an after-death interview regarding the quality of care that the patient received.

Results:

There were no significant differences in caregiver burden between intervention and usual care conditions. Follow-up analyses showed that higher caregiver objective burden and stress burden were related to lower patient quality of life, higher symptom intensity, and higher depressed mood. Caregivers who perceived that patients had unmet needs at end of life reported higher objective burden, and those who perceived that patients were not treated with respect reported higher demand burden.

Significance of results:

The results indicate that a successful patient-focused intervention did not have a similar beneficial effect on caregiver burden. Future interventions should focus on caregivers as well as patients, with particular attention to caregivers' perceptions of patient care, and seek to change both negative and positive effects of informal caregiving.

Keywords

Caregiver burdenInterventionPalliative careCancer
Type
Original Articles
Information
Palliative & Supportive Care , Volume 8 , Issue 4 , December 2010 , pp. 395 - 404
Copyright
Copyright © Cambridge University Press 2010

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