The availability of informational tools such as written materials, audiotapes, and videotapes for caregivers has lagged behind the availability of comparable tools for cancer patients. Family caregivers of cancer patients need their own educational materials that include problem-solving strategies, specific caregiving strategies, and self-care.
Counseling and Psychotherapy
Counseling and psychotherapy are designed to reduce distress by helping caregivers adjust psychologically to the demands of caregiving. These interventions are typically designed to enhance morale, self-esteem, coping, and sense of control while reducing anxiety and depression. Individual counseling is designed to provide caregivers with support, education, and problem-solving or coping skills. However, these interventions are expensive and may prove too time-consuming for working or highly distressed caregivers.
Home Care Services for the Cancer Patient
Home care services provided for the cancer patient generally include caregiver support as part of the plan of care. Caregivers report high rates of satisfaction with such services and describe them as useful.[Level of evidence: I] At the same time, however, studies continue to show high levels of psychological morbidity and unmet needs among caregivers of cancer patients using home care services, suggesting that generic supportive nursing care does not fully meet caregiver needs.
One group of investigators studied whether specialized oncology home care services provided to lung cancer patients influenced bereavement and psychological distress among survivors.[Level of evidence: I] Participants were randomly assigned to an oncology home care group, a standard home care group, or an office care control group. Spouses of patients in the oncology home care group had significantly lower psychological distress than did spouses of patients in either of the other groups. These findings have been corroborated by others.
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.[18,19,20,21]
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.