Hospice Care for the Cancer Patient
Family caregivers of home-based palliative care patients report the need for coaching in practical nursing skills and more access to professional advice to increase their self-confidence and ability to perform the practical aspects of home-based care. In addition, caregivers assisting patients in the final stages of life experience as much distress as patients do, if not more. A meta-analysis of psychological distress among cancer patients and family caregivers found that both members of the dyad experienced similar levels of distress. For these reasons, there is a strong correlation between quality of life scores for patients and their caregivers in hospice home care programs; caregivers continue to report high rates of burden.[16,17,18,19]
Psychoeducational programs provide caregivers of cancer patients with a variety of skills, resources, and problem-solving strategies to help them cope with caregiving. For example, the problem-solving model summarized by the acronym COPE (creativity, optimism, planning, and expert information) is designed to maximize a caregiver's effectiveness, sense of efficacy, and satisfaction. Caregivers are encouraged to develop creative solutions to challenging situations. The COPE problem-solving model:
- Addresses the emotional aspect of problem-solving, combining optimism with realism.
- Helps caregivers develop specific plans to meet their individual situations.
- Teaches caregivers the rationales for what they do.
The authors of the COPE study contend that their model moderates caregiver stress through empowerment and training.
Skills training for caregivers has proven effective in improving their quality of life, reducing the burden associated with symptom management, and in strengthening caregiving tasks. Such programs are effective for caregivers of patients at all stages of cancer, including end-of-life care and hospice. The most effective skills training programs tend to be nursing intervention programs, which combine guidance, support, and nursing home visits. Nurse-led transition coaching programs prepare patients and caregivers for the next level of care, teach communication skills, and follow patients to the home. In addition, the nurses initiate phone calls at 2, 7, and 14 days after discharge, thereby providing continuity of care through a single point of contact.
The effectiveness of psychoeducational programs for caregivers of cancer patients has been mixed. For example, a 6-week problem-solving intervention with spouses of cancer patients was successful at reducing depression; however, there were no effects on coping, social support, or psychological well-being. In another study, 237 cancer patient/caregiver dyads were randomly assigned to one of two groups: a conventional care group or a 20-week experimental group. The focus of the intervention was improving the caregiver's ability in symptom management and reducing their distress. Although the intervention improved caregivers' symptom management abilities, it was not effective in decreasing their depression.