Positive consequences of supporting a dying relative: findings from a randomized controlled trial
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Hudson, Peter, University of Melbourne, Melbourne, Australia |
There have been frequent requests for intervention studies to be undertaken in order to develop evidence based supportive care strategies for palliative care families. A randomised controlled trial (RCT) was undertaken to assess the effectiveness of a psycho- educational intervention for primary family caregivers of patients with advanced cancer who were receiving home based palliative care. The intervention comprised two home nursing visits, interspersed by a phone call, which focused on assessing and implementing supportive caregiving strategies. A caregiver guidebook and audiotape were incorporated to complement the visits and provide an ongoing resource. Participants (n=106) were randomly allocated to receive standard metropolitan community palliative care service (CPCS) provision or the intervention. Data were collected at three time points-Time 1: within two weeks of patient admission to the CPCS; Time 2: five weeks after completing Time 1 data, and Time 3: eight weeks following the patient's death. The main outcomes of interest were caregivers' mastery, self-efficacy, preparedness, competence, social support, optimism, rewards, depression and anxiety. A moderatesized intervention effect was identified on caregivers' rewards at both Time 2 (F (1.73)=8.44, p=0.005), and Time 3 (F (1.43)=4.68, p=0.036), indicating that, as a consequence of the intervention, caregivers were able to recognise more positive aspects associated with their experience. Research to date with family caregivers of dying cancer patients has tended to focus on the negative aspects associated with the role. The results of this study highlight the importance of exploring the positive aspects of caregiving. Otherwise there is a danger of pathologizing caregiving and inadvertently socializing caregivers to only expect burden.
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