Support service use and interest in support services among distressed family caregivers of lung cancer patients.

Lung cancer is one of the most common cancers affecting both men and women, with over 220,000 new cases in the United States expected in 2012 [1]. Most lung cancer patients (85%) have regional or distant stage disease at diagnosis [1], contributing to their high rate (80%) of multiple physical and psychological symptoms [2–4]. Family caregivers often provide informational, emotional, or financial support to ill relatives or friends as well as assistance with medical or personal care [5–6]. Given the extent of family caregiving responsibilities, it is not surprising that up to 50% of cancer patients’ family caregivers report significant distress [7–12]. Lung cancer may be especially distressing for family caregivers because of its high physical symptom burden [13], which may increase caregiving demands, and possible attributions of blame or stigma associated with the patient’s tobacco use [14]. Caregivers of lung cancer patients have reported difficulty with caregiving tasks such as providing emotional support, managing behavior problems, and monitoring symptoms [15]. Spousal caregivers of lung cancer patients have also reported difficulty discussing the patient’s prognosis, symptom management, persistent tobacco use, and their own emotions [16]. One third of spousal caregivers of lung cancer patients have been found to experience clinically elevated anxiety or depressive symptoms [10–11]. Another study of lung cancer patients’ caregivers that included relatives (e.g., spouses, adult children) and friends found that about 40% reported high levels of strain on scales assessing depressive symptoms, exhaustion, and emotional well-being [7]. Although a growing literature has documented the psychosocial impact of lung and other cancers on family caregivers [17–19], their rates of psychosocial support service use are typically low. In a nationally representative survey of primary informal caregivers of chronically disabled community-dwelling older adults, including those with cancer, less than 5% of caregivers reported participating in a caregiver support group or using respite services [20]. Another study found that fewer than half (46%) of advanced cancer patients’ caregivers with a psychiatric diagnosis sought mental health care [21]. Little is known about caregivers’ complementary and alternative medicine (CAM) use and interest in CAM and other support services. What factors might explain the observation that despite caregivers of cancer patients reporting high rates of distress [7–8, 12], they tend to report low rates of mental health service use [21]? Knowledge about caregivers’ interest in a range of support services and a greater understanding of factors that are predictive of support service use is essential for guiding the development of interventions that are acceptable and readily sustainable in clinical practice. To address these gaps in the literature, the present study examined use of mental health services and CAM and interest in support services among distressed family caregivers of lung cancer patients. Distress was defined as meeting the clinical cutoff for significant anxiety or depressive symptoms on a standardized and widely used self-report measure. Caregivers’ use of mental health services and CAM was assessed within 12 weeks of the patient’s initial visit to the oncology clinic and three months later to determine uptake of services during the early phase of cancer care at comprehensive medical centers. We focused on the early phase of care because it represents an initial period of heightened distress and immersion into caregiving responsibilities [10]. Family caregivers who report heightened distress during the initial phase of treatment are likely to benefit from early identification and encouragement to access available support services [19]. Andersen’s behavioral model of healthcare use [22] was the organizing framework for the current study. This widely supported model has substantial relevance to understanding use of mental health services and CAM [23]. The model posits that healthcare use is influenced by three factors: 1) predisposing factors such as gender, age, race, marital status, education, and occupation; 2) enabling or access-related factors such as income, health insurance, and transportation; and 3) need for services as indicated by psychiatric symptoms and perceptions of functional capacity. An example of these perceptions is coping self-efficacy (e.g., confidence in one’s ability to solve problems or stop unpleasant thoughts and emotions) [24]. The present study assessed predisposing, enabling, and need variables as potential correlates of mental health service use, CAM use, and interest in support services. The aims of this study are: (1) to examine distressed caregivers’ use of mental health services (e.g., psychotherapy, medication) and CAM (e.g., yoga, meditation, massage) during the initial period of care at an oncology clinic; (2) to determine caregivers’ interest in various support services (e.g., talking to a staff member about one’s feelings, support group, CAM, professional help with practical needs); and (3) to examine the extent to which predisposing factors (e.g., age, gender), enabling factors (e.g., income, transportation), and need variables (i.e., anxiety and depressive symptoms and coping self-efficacy) are associated with caregivers’ use of mental health services and CAM and interest in mental health services (i.e., talking to a staff member about one’s feelings, support group), CAM, and professional help with practical needs. The extent to which patient medical factors (e.g., cancer stage, cancer treatments) were correlated with these outcomes also was explored. Based on Andersen’s model of healthcare use [22] and prior research [25–29], the following correlates of mental health service use, CAM use, and interest in mental health services and CAM were hypothesized: Predisposing factors would include younger age, female gender, unmarried status, greater education, and less caregiving responsibility (i.e., not caring for multiple family members). Enabling factors would include greater income, fewer transportation difficulties, and the receipt of caregiving assistance. Need variables would include greater anxiety and depressive symptoms and lower levels of coping self-efficacy. We also hypothesized that lower levels of income and education, greater transportation difficulties, and greater caregiving responsibility would be associated with greater interest in professional help with practical needs.