Effect of an Integrated Cancer Support Team on Caregiver Satisfaction With End-of-Life Care

The importance of attending to family needs as an integral part of quality cancer care has been recognized (American Cancer Society, 2014; National Cancer Institute, 2014). An increase in reports of intervention trials to support families has occurred, particularly when a family member has advanced cancer (Northouse, Katapodi, Song, Zhang, & Mood, 2010). The needs of family caregivers have been described as including emotional support or education and practical help in performing tasks of caregiving. Because the care of patients with cancer has increasingly moved to the home, families are taxed with demands for providing physical care, medication administration, and symptom monitoring (Glajchen, 2004). All of those needs have been noted to increase at the end of life (EOL) (Cameron, Franche, Cheung, & Stewart, 2002; Kim & Given, 2008). Although the quality of care for patients with cancer at EOL has become a major focus of research and quality improvement initiatives, far less attention has been paid to the experience, needs, and satisfaction of family caregivers in the final phase of illness. A number of studies have been performed with mixed samples of families of patients with and without cancer, which have provided some important insights (Steinhauser et al., 2000; Teno, Casey, Welch, & Edgman-Levitan, 2001). Among the items consistently rated as important at EOL by a large sample of seriously ill patients, bereaved family members, and healthcare providers were pain and symptom management and preparation for death (Steinhauser et al., 2000). Others have identified five domains of EOL care that defined quality: physical comfort, control of decisions, relieving family members of the burden of being the constant advocate, education of family members to instill confidence in caring for the loved one, and emotional support of the family (Teno et al., 2001). The study of effective interventions for family caregivers of people with cancer at EOL is complicated by the recognized influence of situational and individual psychodynamic factors. Presence of social resources and subjective appraisal of stress have been identified as significant predictors of caregiver depression and life satisfaction (Haley, LaMonde, Han, Burton & Schon-wetter, 2003), and stress appraisal and coping resources have been identified as key mediating variables influencing caregiver outcomes (Northouse, 2005). The investigation reported in the current article is part of a larger study conducted to test the effect of integrating an interdisciplinary cancer support team (CST) into the routine care of patients with advanced lung, gastrointestinal (GI), or gynecologic (GYN) cancer. The primary aims of that study were patient centered (i.e., quality of life and quality of care at EOL); however, the intervention was designed to include assessment and support of family caregivers. The inclusion of family caregivers gave the authors the opportunity to examine family outcomes (e.g., satisfaction with care at EOL) and the possible influence of mood state and social support on family satisfaction. The purpose of the current article is to report the results of providing an interdisciplinary comprehensive support program to the families of patients with advanced cancer in the last phase of life.