The determinants of the intensity of home-based informal care among cancer patients in receipt of home-based palliative care

2020 ◽  
pp. 026921632097927
Author(s):  
Jiaoli Cai ◽  
Li Zhang ◽  
Denise Guerriere ◽  
Peter C Coyte
Keyword(s):  
Palliative Care ◽  
Marital Status ◽  
Cancer Patients ◽  
Informal Care ◽  
Instrumental Variables ◽  
Spousal Caregivers ◽  
Living Alone ◽  
Policy Makers ◽  
Cohort Design ◽  
Home Based

Background: Understanding the determinants of the intensity of informal care may assist policy makers in the identification of supports for informal caregivers. Little is known about the utilization of informal care throughout the palliative care trajectory. Aim: The purpose of this study was to analyze the intensity and determinants of the use of informal care among cancer patients over the palliative care trajectory. Design: This was a longitudinal, prospective cohort design conducted in Canada. Regression analysis using instrumental variables was applied. Setting/participants: From November 2013 to August 2017, a total of 273 caregivers of cancer patients were interviewed biweekly over the course of the care recipient’s palliative care trajectory. The outcome was the number of hours of informal care provided by unpaid caregivers, that is, hours of informal care. Results: The number of hours of informal care increased as patients approached death. Home-based nursing care complemented, and hence, increased the provision of informal care. Patients living alone and caregivers who were employed were associated with the provision of fewer hours of informal care. Spousal caregivers provided more hours of informal care. Patient’s age, sex, and marital status, and caregiver’s age, sex, marital status, and education were associated with the number of hours of informal care. Conclusions: The intensity of informal care was determined by predisposing, enabling, and needs-based factors. This study provides a reference for the planning and targeting of supports for the provision of informal care.

Impact of racial and marital status on health services utilization among veterans with terminal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19639-e19639
Author(s):  
Zhiqiang Kevin Lu ◽  
Zaina P. Qureshi ◽  
Michael Cho ◽  
Trent P Wang ◽  
Houling Yan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Health Services ◽  
Marital Status ◽  
Cancer Patients ◽  
Health Services Utilization ◽  
Terminal Cancer ◽  
Never Married ◽  
Services Utilization ◽  
Hospital Days ◽  
Clinic Visits

e19639 Background: Little is known about the association of socio-demographic factors with health services utilization (HSU) for patients with terminal cancer receiving palliative care. The objectives of this study were to evaluate for race or marital status associated variations in HSU among Veterans with terminal cancer. Methods: In an IRB approved protocol, 103 advanced cancer patients receiving palliative care in the Section of Hematology Oncology at a VA Medical Center, but not hospice, were followed every 4-6 weeks from the start of palliative care to death from 2000-2002. This study sample consisted of a subset of 39 pts who received palliative care for at least 24 weeks. Their charts were retrospectively reviewed for measures of health system utilization (HSU), including total length of hospital days, number of admissions, number of clinic visits and emergency room (ER) visits. ANOVA and Chi-square tests were used to explore for potential disparities of HSU across race or marital status. Results: Overall, the subset consisted of 17 Caucasians, 21 African American (AA), and 1 “other” by race. Among them, 21 were married, 7 were divorced, 6 were widowed, 4 never married and 1 had unknown marital status. The majority of patients had prostate cancer (39.47%) or lung cancer (28.95%). Mean total number of inpatient days was 23.6 days (SD=23), mean number of admissions was 2.9(SD=2.5), mean number of clinic visits was 27 (SD=25), and ER visits was 1.3(SD=1.8) per patient. Mean total hospital days were the longer for AA (25) compared to Caucasian (17.7) (p<0.01); the one pt from “other” had a total of 94 hospital days. The average number of ER visits was 0.48 for Caucasian, 2.0 for AA and 0 for other (p<0.05). Total number of inpatient days was longest for those who were never married (33.8 days), less for those who were married (26.0), divorced (12.7) or widowed (9.3) (p>0.05). A similar trend was found for clinic visits (NS). Conclusions: The pilot study identified racial but not marital status-associated variations in HSU among terminally ill cancer patients. These findings have implications for cost of care and should be confirmed in larger studies in our Veterans including caregivers. Funded in part by Project Death in America

What Variables Contribute to the Achievement of a Preferred Home Death for Cancer Patients in Receipt of Home-Based Palliative Care in Canada?

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jiaoli Cai ◽  
Li Zhang ◽  
Denise Guerriere ◽  
Hongli Fan ◽  
Peter C. Coyte
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Home Death ◽  
Home Based

Caregiving at the end of life: Perspectives from spousal caregivers and care recipients

2007 ◽  
Vol 5 (1) ◽  
pp. 11-17 ◽  
Author(s):  
SUSAN JO ◽  
KEVIN BRAZIL ◽  
LYNNE LOHFELD ◽  
KATHLEEN WILLISON
Keyword(s):  
Palliative Care ◽  
Family Relationship ◽  
Home Care Services ◽  
Research Strategy ◽  
Spousal Caregivers ◽  
Care Recipient ◽  
Financial Strain ◽  
Care Services ◽  
Care Recipients ◽  
Home Based

Objective: The purpose of this study is to examine the perspectives of both the spousal caregiver and care recipient on the caregiving experience in home-based palliative care.Methods: A qualitative research strategy involving home-based face-to-face interviews with older palliative care patients and their spousal caregivers was used to examine the caregiving experience.Results: Ten spousal caregivers and care recipient dyads participated in the study. Most informal caregivers viewed caregiving as an extension of the family relationship where caregiving responsibilities evolved over time. Spousal caregivers identified many negative reactions to caregiving, such as fatigue or weariness, depression, anger and sadness, financial stresses, and lack of time. Care recipients acknowledged the emotional and financial strain and expressed concern for their spouses. Both caregivers and care recipients were appreciative of home care services although they identified the need for additional services. They also identified difficulties in communication with formal providers and poor coordination of care among the various services. Both caregivers and care recipients disclosed some challenges with informal supports, but on the whole felt that their presence was positive. Additional positive aspects of caregiving reported by spouses included strengthened relationship with their spouse and discovering emotional strength and physical abilities in managing care.Significance of results: Health care and social service professionals need to recognize and understand both caregiver and care recipient perspectives if they are to successfully meet the needs of both members of the dyad.

scholarly journals Anorexia as a Risk Factor of Mortality in Patients with Advanced Lung Cancer Receiving Home-Base Palliative Care

2021 ◽  
Author(s):  
Jiaxin Cui ◽  
Lanhui Tan ◽  
Pei Fang ◽  
Zifen An ◽  
Jiayi Du ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Advanced Lung Cancer ◽  
Lung Cancer Patients ◽  
Home Based

Abstract Purpose To determine the prevalence of anorexia among advanced lung cancer patients at the beginning of receiving home-based palliative care and to examine the predictive role of anorexia in survival of patients with advanced lung cancer. Methods In this retrospective study, we analyzed data from 918 advanced lung cancer patients who had received home-based palliative care between March 2010 and March 2020. We used Kaplan-Meier survival curves to determine the factors associated with survival time and applied the Cox proportional hazards model to examine the effect of anorexia on survival. Results The study included 918 patients with a mean age of 63.5 years; and 72.2% of them were men. Factors associated with shortened survival included gender, place of residence, weight loss, anorexia, nausea and Karnofsky performance status (KPS). In a multivariable Cox proportional hazards model, after adjusting for male gender, patient lives in city, and low KPS, we found that anorexia was an independent negative predictor of survival. Conclusions As an independent factor predicting the survival of patients with advanced lung cancer, anorexia should be taken seriously by medical staff. This predictive factor may serve as early risk identification indicator for healthcare workers who provide home-based palliative care, thereby providing personalized palliative care for advanced lung cancer patients.

scholarly journals Difficulties to Provide Palliative Care in West Bengal, India

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 172s-172s
Author(s):  
A. Manna
Keyword(s):  
Palliative Care ◽  
Cancer Patient ◽  
Cancer Patients ◽  
West Bengal ◽  
Family Members ◽  
Local People ◽  
Terminal Cancer ◽  
Home Based ◽  
Terminal Cancer Patients ◽  
Result Analysis

Objective: In a southern district of West Bengal, India almost 75% of cancer patient die a sad death of neglect due to lack of awareness about palliative care and low economic level. To identify and try to solve to the extent possible the main difficulties in giving palliative care to the terminal cancer patients of the area. Method: Home visit by volunteers and enumeration of the problems as discussed by the patient and their families. Result: Analysis the following data and identify these main problems. Patient problems: Pain, vomiting, respiratory distress, fatigue, etc. Our volunteers visited terminal cancer patients and their families in our areas. Family problems: Inability to match work life with the care of the patients. Adverse attitude of neighbors and local peoples. Social problems: Lack of awareness of the neighbor of local people about cancer and palliative care resulting in isolation of the family. Projected Intervention: Trying to relieve the patient's problems through home based medications and intervention by volunteers and family members. Reorientating the attitude of family members through discussions and other methods of communication (i.e., get-together of cancer survivors). Social effort to raise the awareness of neighbors and local people through discussion and other audio visual method (i.e., poster, leaflet, slide presentation, etc.). Conclusion: We believe that if we are able to continue our program for a long enough period the suffering of the terminal cancer patient and their families might be resolved to a large extent over time.

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