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Palliative Medicine The Research Journal of the EAPC
Article Reviews
| Issue |
Article Reference |
Reviewer
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| 2004 18(2): |
GI Ringdal, et al.: Health-related Quality of Life (HRQOL) in Family Members of Cancer Victims: Results from a Longitudinal Intervention Study in Norway and Sweden.
Palliative Medicine 2004; 18: 108-120 |
Nicholas Christakis, Boston, USA |
| Background |
Family members caring for patients dying of cancer may experience changes in their own quality of life for at least two different reasons. First, with the passage of time, as they confront the periods of illness, death, and bereavement in their experience of caring for the patient, their health-related quality of life might vary -- reaching a nadir at the time of the patient’s death. Second, it seems likely that the provision of palliative care services to the decedent and to the family before and after the death of the patient might modify, and specifically improve, the health-related quality of life of family members.
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| Results |
| The study confirmed that on virtually all of the subscales related to quality of life (including physical functioning, bodily pain, social functioning, mental health, etc.) there was a roughly parabolic shape with a low point in health-related quality of life in the caregivers being reached at approximately the time of death of the patients; thereafter, there was a gradual recovery and return to baseline. In addition, for two of the subscales, i.e., the mental health of caregivers and their emotional role limitations, the delivery of palliative care to decedents resulted in better health-related quality of life in caregivers. There was a trend of the same type for most of the other HRQOL subscales as well.. |
| Methods and study design |
| This study took place at two different sites, one in Norway and one in Sweden. At the Norwegian site, there were 183 caregivers in the intervention arm (where patients got palliative care) and 130 in the control arm (where they did not) and in the Swedish site there were 102 in each of the two arms. The majority of caregivers were spouses. Pertinently, the Norwegian site commendably involved random assignment of patients and caregivers to the intervention arm. The SF36, a standard measure of health-related quality of life with several sub-scales, was administered to caregivers at repeated time intervals from roughly one year prior to death of the patient to roughly one year after the death of the patients. Linear random coefficient models accounting for the repeated measures within subjects were implemented. |
| Comments: Suggestions for further development / Open Questions |
| This excellent study adds to our knowledge both of the response of caregivers to the burden of caring for seriously ill patients, and also to our knowledge of the impact of palliative medicine on patients and their families. Prior work in this area -- by Cameron and Parkes, by Addington-Hall et al, and by Christakis and Iwashyna -- speak to one or the other of these concerns. But this is the first and most comprehensive study to use a comprehensive measure of health-related quality of life over a long time period in a large sample of patients some of whom have and some of whom have not been assigned to the receipt of palliative care |
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