Objective: A key aspect of the role of clinicians caring for
patients in the setting of advanced illness focuses on attending to the
needs of informal caregivers during the end-of-life period. The purpose
of this study was twofold: (1) to complement and enrich existing
quantitative findings regarding caregiver burden near the end of life,
and (2) to identify potential solutions to caregivers' unmet needs
in an effort to assist clinicians in the development of clinical
interventions.
Methods: This qualitative study, using focus groups and
content analysis of transcripts, was conducted in a comprehensive
cancer center in Washington, DC. Seven focus groups were held: three
with recently bereaved caregivers and four with active caregivers of
patients with metastatic cancer and an expected survival of 6 to 12
months.
Results: Data were stratified into two broad categories: (1)
general problems and (2) behaviors/activities that were
helpful/would have been helpful in alleviating these problems.
Within each of these two categories, five subcategories emerged:
medical care (including provision of information, coordination of care,
bedside manner, satisfaction with care), quality of life (including
well-being, role adjustments), help from others (including practical
assistance, social support), positives of caregiving, and unsolicited
themes (including job flexibility, impact of the disease on the family,
informational needs, relationship with patient).
Significance of results: Results suggest caregivers may
benefit from more information about patient prognosis and hospice,
attention to quality-of-life issues, and enhanced, direct communication
with clinicians. Although information of this nature is likely to be
known to palliative care clinicians, the specific details and verbal
insights provided by caregivers give an important voice to existing
quantitative data and may provide more detailed information to assist
palliative care clinicians seeking to develop interventions to meet
caregiver needs during the period near the end of life.