Impact of early palliative care on caregivers of patients with advanced cancer: cluster randomised trial Improving support for family carers: Key implications for research, policy and practice The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Positive aspects and challenges associated with caring for a dying relative at home. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. Reducing the psychological distress of family caregivers of home based palliative care patients: longer term effects from a randomised controlled trial ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions A pilot randomized, controlled trial of the effectiveness of a psychoeducational intervention on family caregivers of patients with advanced cancer. Benefits of Early Versus Delayed Palliative Care to Informal Family Caregivers of Patients With Advanced Cancer: Outcomes From the ENABLE III Randomized Controlled Trial. A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: results of the Pleasant Events Program (PEP). Randomized clinical trial of a brief and extensive dyadic intervention for advanced cancer patients and their family caregivers. Reducing the psychological distress of family caregivers of home-based palliative care patients: short-term effects from a randomised controlled trial. CHESS improves cancer caregivers' burden and mood: results of an eHealth RCT. Palliative respite services using nursing staff reduces hospitalization of patients and improves acceptance among carers. Short-term and long-term effects of a psycho-educational group intervention for family caregivers in palliative home care - results from a randomized control trial. Predictors of caregiver burden across the home-based palliative care trajectory in Ontario, Canada.
Background Early palliative care improves the quality of life ( QoL ) and satisfaction with care of patients with advanced cancer , but little is known about its effect on caregivers . Here , we report outcomes of caregiver satisfaction with care and QoL from a trial of early palliative care . Patients and methods Twenty-four medical oncology clinics were cluster-r and omised , stratified by tumour site ( lung , gastrointestinal , genitourinary , breast and gynaecological ) , to early palliative care team referral , or to st and ard oncology care with palliative care only as needed . Caregivers of patients with advanced cancer ( clinical prognosis of 6 - 24 months , Eastern Cooperative Oncology Group 0 - 2 ) in both trial arms completed vali date d measures assessing  satisfaction with care  ( FAMCARE-19 ) and  QoL [ SF-36v2 Health Survey ; Caregiver QoL-Cancer ( CQoL-C ) ] , at baseline and monthly for 4 months . We used a multilevel linear r and om-intercept mixed-effect model to test whether there was improvement in the intervention group relative to the control group over 3 and 4 months . Results A total of 182 caregivers completed baseline measures ( 94 intervention , 88 control ) ; 151 caregivers ( 77 intervention , 74 control ) completed at least one follow-up assessment . Satisfaction with care improved in the palliative intervention group compared with controls over 3 months ( P = 0.007 ) and 4 months ( P = 0.02 ) . There was no significant improvement in the intervention group compared with controls for CQoL-C ( 3 months : P = 0.92 , 4 months : P = 0.51 ) , Physical Component Summary of the SF-36v2 Health Survey ( 3 months : P = 0.83 , 4 months : P = 0.20 ) , or Mental Component Summary of the SF-36v2 Health Survey ( 3 months : P = 0.87 , 4 months : P = 0.60 ) . Conclusion Early palliative care increased satisfaction with care in caregivers of patients with advanced cancer . Clinical Trials.gov identifier NCT01248624 The aim of this editorial is to highlight several research priorities and key implication s for policy and practice that inform an agenda to improve family carer support . The development of systematic approaches to identify carers who are at risk of poor psychosocial outcomes  is a priority . Family caregiving should not be pathologised as an inherently negative experience ; however , it would be a breach of care if more than 40 % of carers who appear to meet the criteria for psychological distress1 are not offered suitable supports . Related to this is the urgent need for greater investment in bereavement research ; while bereavement support is integral to palliative care , it is typically under-re source d , under-investigated and not systematic ally applied . We know that routine intervention for all bereaved carers is not warranted . The challenge is to discern those carers who are ‘ at risk ’ prior to the death of the patient and to identify suitable evidence -based strategies to assist them . Research indicates that carer re sources , rather than patient diagnosis or illness severity , are the primary predictors of carer burden and other carer outcomes . This implies that although the specific content may need to vary to suit the context , the core elements of family carer interventions may be relevant across disease groups . It is also apparent that the perceived quality of social support is more important than the size of the social network in improving carer outcomes .2 Current indications are that palliative care providers should assist carers by targeting social support and re sources and provide education that focuses on coping strategies and preparation for the carer role . In many countries , family carers are well prepared for the beginning of life when , for example , prospect i ve parents are routinely offered parenting classes . It is also not uncommon to assist carers prepare for and support relatives having major heart surgery . However , preparation for supporting a relative/ friend at the end of their life is not routinely offered . Carers typically want to know what the role entails , how to manage symptoms , signs of imminent death and re sources and strategies to sustain their own well-being . Given the majority of patients want to be cared for in their home environment , initiatives that assist carers to achieve this are needed . The period of time most people receive palliative care services is typically quite short ; hence , the challenge is to design interventions that are as brief as possible , readily accessible and easily delivered . The significant number of carers who support patients in the hospital/hospice setting should also not be neglected ; their needs are often hidden . Other valuable insights regarding how we deliver interventions are surfacing . For example , the conception that face-to-face carer support is the gold st and ard is being challenged . Emerging evidence suggests that telephone and video phone support may be equally effective in some circumstances.1,3 Emphasis on the development of a strategic , coordinated and priority-driven family carer research agenda is also important.4 The role of formal research collaborations may be a vehicle to foster this . Much of the carer research seems to be first-world centric . More attention needs to be directed towards family caregiving in under-re source d countries and in other under-represented population s such as ethnic minority groups . Several important policy and clinical matters warrant consideration if palliative care is to foster improved carer support . One of the core questions for policymakers and clinicians is whether or not it is feasible for palliative care to be expected to meet the needs of the patients ’ entire family . It has been recommended that given re source constraints , the focus should be on the primary family carer ( as identified by the patient ) and where possible extended to other family members.5 Consideration might also be given to revising expectations about the goal of family support . The current World Health Organization definition of palliative care advocates that families ’ quality of life be improved ; perhaps a more realistic objective may be to aim to reduce the psychosocial burden of primary family carers . A related question is how to effectively legitimise family carer support . Most family carers do not want to discuss their needs and concerns in front of their relative ; they therefore need one-to-one time with healthcare and socialcare professionals . It is also clear that many healthcare workers find supporting carers challenging . Hence , where pertinent , consideration should be given to the potential merits of officially recognising family carers as ‘ care recipients ’ ; therefore , they are formally acknowledged as ‘ worthy ’ within the healthcare system . This may help justify much needed re sources and allow healthcare workers to allocate time and where pertinent offer interventions . In 488855 PMJ27710.1177/0269216313488855Palliative MedicineEditorial Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Research has consistently shown that family caregivers have a variety of unmet needs , despite comprehensive professional support for caregivers being a central aim of palliative care . This sub- study of a larger r and omized controlled trial sought feedback from 47 primary family caregivers of advanced cancer patients who had recently commenced home palliative care .  During semi-structured interviews in their homes , family caregivers were asked to comment on the key challenges associated with their role and whether they could identify challenges . These were associated with their own ill health , family circumstances , insufficient skills to manage patient symptoms , limited time for themselves and inadequate support from health professionals . Despite these challenges , 60 % of family caregivers were readily able to identify positive aspects of the role . Previous research has tended to focus on the negative impact of caregiving . The extent to which the positive aspects buffer the negative aspects of the role warrants further exploration , as does the long-term impact of the caregiver role on those who are unable to recognize positive elements BACKGROUND It is commonly written that more patients wish to die at home than currently achieve this . However , the evidence for preferences for place of terminal care and death has not been systematic ally review ed . AIM To carry out a systematic literature review of the preferences for  place of care and death  among advanced cancer patients . METHOD Studies were identified using systematic data base search es of MEDLINE ( 1966 - 1999 ) , PsychLit ( 1974 - 1999 ) , and Bath Information Data Service ( BIDS ) ( 1981 - 1999 ) . Studies were assessed and data extracted and synthesis es following the NHS Centre for Review s and Dissemination guidelines , grading studies according to design and rigor of methods . Studies of preferences in the general population and of groups including cancer patients and /or their caregivers were included . RESULTS Eighteen studies determining preferences in either the general population or groups including cancer patients were identified . Views were obtained prospect ively and retrospectively from patients , the general population , families , and professionals . Respondents indicated preferences for home death ( range 49%-100 % ) , except one study of patients in the care of a continuing care team in London where only 25%-29 % of patients wanted a home death , and inpatient hospice was the most favored option . However , the response rate of this study was not known . Among the general public there was a higher preference for  inpatient hospice care among in people with recent experience of a close friend or relative 's death or dying . Where the views of patients , families , and professionals were compared , all respondents broadly agreed although patients expressed the strongest home preferences . Only 2 of the studies provided longitudinal data , and 9 of the 18 had major deficits in design or reporting , such as poor or unknown response rate , unclear or un systematic methods of eliciting preferences or other sample or measurement bias . However , sensitivity analysis of only the more robust and larger studies did not alter the finding of a preference for home care at the end of life in over 50 % of patients . CONCLUSIONS Home care is the most common preference , with inpatient hospice care as second preference in advanced illness . Meeting these preferences could be important outcomes for services . Study design s in this area need to be improved CONTEXT There are few r and omized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer . OBJECTIVE To determine the effect of a nursing-led intervention on quality of life , symptom intensity , mood , and re source use in patients with advanced cancer . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from November 2003 through May 2008 of 322 patients with advanced cancer in a rural , National Cancer Institute- design ated comprehensive cancer center in New Hampshire and affiliated outreach clinics and a VA medical center in Vermont . INTERVENTIONS A multicomponent , psychoeducational intervention ( Project ENABLE [ Educate , Nurture , Advise , Before Life Ends ] ) conducted by advanced practice nurses consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion ( n = 161 ) vs usual care ( n = 161 ) . MAIN OUTCOME MEASURES Quality of life was measured by the Functional Assessment of Chronic Illness Therapy for Palliative Care ( score range , 0 - 184 ) . Symptom intensity was measured by the Edmonton Symptom Assessment Scale ( score range , 0 - 900 ) . Mood was measured by the Center for Epidemiological Studies Depression Scale ( range , 0 - 60 ) . These measures were assessed at baseline , 1 month , and every 3 months until death or study completion . Intensity of service was measured as the number of days in the hospital and in the intensive care unit ( ICU ) and the number of emergency department visits recorded in the electronic medical record . RESULTS A total of 322 participants with cancer of the gastrointestinal tract ( 41 % ; 67 in the usual care group vs 66 in the intervention group ) , lung ( 36 % ; 58 vs 59 ) , genitourinary tract ( 12 % ; 20 vs 19 ) , and breast ( 10 % ; 16 vs 17 ) were r and omized . The estimated treatment effects ( intervention minus usual care ) for all participants were a mean ( SE ) of 4.6 ( 2 ) for quality of life ( P = .02 ) , -27.8 ( 15 ) for symptom intensity ( P = .06 ) , and -1.8 ( 0.81 ) for depressed mood ( P = .02 ) . The estimated treatment effects in participants who died during the study were a mean ( SE ) of 8.6 ( 3.6 ) for quality of life ( P = .02 ) , -24.2 ( 20.5 ) for symptom intensity ( P = .24 ) , and -2.7 ( 1.2 ) for depressed mood ( P = .03 ) . Intensity of service did not differ between the 2 groups . CONCLUSION Compared with participants receiving usual oncology care , those receiving a nurse-led , palliative care-focused intervention addressing physical , psychosocial , and care coordination provided concurrently with oncology care had higher scores for quality of life and mood , but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or emergency department visits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00253383 Background Palliative care incorporates comprehensive support of family caregivers because many of them experience burden and distress . However , evidence -based support initiatives are few . Purpose We evaluated a one-to-one psychoeducational intervention aim ed at mitigating the distress of caregivers of patients with advanced cancer receiving home-based palliative care . We hypothesised that caregivers would report decreased distress as assessed by the General Health Question naire ( GHQ ) . Method A r and omised controlled trial comparing two versions of the delivery of the intervention ( one face-to-face home visit plus telephone calls versus two visits ) plus st and ard care to a control group ( st and ard care only )  across four sites in Australia . Results Recruitment to the one visit condition was 57 , the two visit condition 93 , and the control 148 . We previously reported non-significant changes in distress between times 1 ( baseline ) and 2 ( 1-week post-intervention ) but significant gains in competence and preparedness . We report here changes in distress between times 1 and 3 ( 8-week post-death ) . There was significantly less worsening in distress between times 1 and 3 in the one visit intervention group than in the control group ; however , no significant difference was found between the two visit intervention and the control group . Conclusions These results are consistent with the aim of the intervention , and they support existing evidence demonstrating that relatively short psychoeducational interventions can help family caregivers who are supporting a dying relative . The sustained benefit during the bereavement period may also have positive re source implication s , which should be the subject of future inquiry . © 2014 The Authors . Psycho-Oncology published by John Wiley & Sons Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies PURPOSE / OBJECTIVES To evaluate the effectiveness of a psychoeducational intervention , the Caring for the Caregiver Programme ( CCP ) . DESIGN A pilot r and omized , controlled trial , two-group pretest , and repeated post-tests . SETTING Four home hospice organizations and an outpatient clinic in Singapore . SAMPLE 80 caregivers were r and omized into experimental and st and ard care groups . METHODS Outcomes were measured at baseline , week 4 , and week 8 after the intervention . The st and ard care group received routine home hospice care , and the intervention group received the CCP in addition to routine care . MAIN RESEARCH VARIABLES Quality of life ( QOL ) , social support , stress and depression , self-efficacy in self-care , closeness with the patient , rewards , and knowledge . FINDINGS Compared to the st and ard care group , the intervention group reported significantly higher QOL , social support satisfaction and number of supported people , closeness with the patient , self-efficacy in self-care , rewards of caregiving , and knowledge , and lower stress and depression . CONCLUSIONS The CCP had positive effects on family caregivers of patients with advanced cancer . IMPLICATION S FOR NURSING A psychoeducational intervention potentially could help caregivers cope with the dem and s of caregiving PURPOSE To determine the effect of early versus delayed initiation of a palliative care intervention for family caregivers ( CGs ) of patients with advanced cancer . PATIENTS AND METHODS Between October 2010 and March 2013 , CGs of patients with advanced cancer were r and omly assigned to receive three structured weekly telephone coaching sessions , monthly follow-up , and a bereavement call either early after enrollment or 3 months later . CGs of patients with advanced cancer were recruited from a National Cancer Institute cancer center , a Veterans Administration Medical Center , and two community outreach clinics . Outcomes were quality of life ( QOL ) , depression , and burden ( objective , stress , and dem and ) . RESULTS A total of 122 CGs ( early , n = 61 ; delayed , n = 61 ) of 207 patients participated ; average age was 60 years , and most were female ( 78.7 % ) and white ( 92.6 % ) . Between-group differences in depression scores from enrollment to 3 months ( before delayed group started intervention ) favored the early group ( mean difference , -3.4 ; SE , 1.5 ; d = -.32 ; P = .02 ) . There were no differences in QOL ( mean difference , -2 ; SE , 2.3 ; d = -.13 ; P = .39 ) or burden ( objective : mean difference , 0.3 ; SE , .7 ; d = .09 ; P = .64 ; stress : mean difference , -.5 ; SE , .5 ; d = -.2 ; P = .29 ; dem and : mean difference , 0 ; SE , .7 ; d = -.01 ; P = .97 ) . In decedents ' CGs , a terminal decline analysis indicated between-group differences favoring the early group for depression ( mean difference , -3.8 ; SE , 1.5 ; d = -.39 ; P = .02 ) and stress burden ( mean difference , -1.1 ; SE , .4 ; d = -.44 ; P = .01 ) but not for QOL ( mean difference , -4.9 ; SE , 2.6 ; d = -.3 ; P = .07 ) , objective burden ( mean difference , -.6 ; SE , .6 ; d = -.18 ; P = .27 ) , or dem and burden ( mean difference , -.7 ; SE , .6 ; d = -.23 ; P = .22 ) . CONCLUSION Early-group CGs had lower depression scores at 3 months and lower depression and stress burden in the terminal decline analysis . Palliative care for CGs should be initiated as early as possible to maximize benefits Dementia caregiving is associated with elevations in depressive symptoms and increased risk for cardiovascular diseases ( CVD ) . This study evaluated the efficacy of the Pleasant Events Program ( PEP ) , a 6-week Behavioral Activation intervention design ed to reduce CVD risk and depressive symptoms in caregivers . One hundred dementia family caregivers were r and omized to either the 6-week PEP intervention ( N = 49 ) or a time-equivalent Information-Support ( IS ) control condition ( N = 51 ) . Assessment s were completed pre- and post-intervention and at 1-year follow-up . Biological assessment s included CVD risk markers Interleukin-6 ( IL-6 ) and D-dimer . Psychosocial outcomes included depressive symptoms , positive affect , and negative affect . Participants receiving the PEP intervention had significantly greater reductions in IL-6 ( p = .040 ) , depressive symptoms ( p = .039 ) , and negative affect ( p = .021 ) from pre- to post-treatment . For IL-6 , clinical ly significant improvement was observed in 20.0 % of PEP participants and 6.5 % of IS participants . For depressive symptoms , clinical ly significant improvement was found for 32.7 % of PEP vs 11.8 % of IS participants . Group differences in change from baseline to 1-year follow-up were non-significant for all outcomes . The PEP program decreased depression and improved a measure of physiological health in older dementia caregivers . Future research should examine the efficacy of PEP for improving other CVD biomarkers and seek to sustain the intervention 's effects BACKGROUND Few intervention programs assist patients and their family caregivers to manage advanced cancer and maintain their quality of life ( QOL ) . This study examined ( i ) whether patient-caregiver dyads ( i.e. , pairs ) r and omly assigned to a brief or extensive dyadic intervention ( the FOCUS Program ) had better outcomes than dyads r and omly assigned to usual care and ( ii ) whether patients ' risk for distress and other factors moderated the effect of the brief or extensive program on outcomes . METHODS Advanced cancer patients and their caregivers ( N = 484 dyads ) were stratified by patients ' baseline risk for distress ( high versus low ) , cancer type ( lung , colorectal , breast , or prostate ) , and research site and then r and omly assigned to a brief ( three-session ) or extensive ( six-session ) intervention or control . The interventions offered dyads information and support . Intermediary outcomes were appraisal s ( i.e. , appraisal of illness/caregiving , uncertainty , and hopelessness ) and re sources ( i.e. , coping , interpersonal relationships , and self-efficacy ) . The primary outcome was QOL . Data were collected prior to intervention and post-intervention ( 3 and 6 months from baseline ) . The final sample was 302 dyads . Repeated measures MANCOVA was used to evaluate outcomes . RESULTS Significant group by time interactions showed that there was an improvement in dyads ' coping ( p < 0.05 ) , self-efficacy ( p < 0.05 ) , and social QOL ( p < 0.01 ) and in caregivers ' emotional QOL ( p < 0.05 ) . Effects varied by intervention dose . Most effects were found at 3 months only . Risk for distress accounted for very few moderation effects . CONCLUSIONS Both brief and extensive programs had positive outcomes for patient-caregiver dyads , but few sustained effects . Patient-caregiver dyads benefit when viewed as the ' unit of care ' BACKGROUND Palliative care is expected to incorporate comprehensive support for family caregivers given that many caregivers suffer psychological morbidity . However , systematic ally implemented evidence -based psychological support initiatives are lacking . AIM The objective of this study was to prepare caregivers for the role of supporting a patient with advanced cancer receiving home-based palliative care by offering a one-to-one psycho-educational intervention . We hypothesised that primary family caregivers who participated in the intervention would report decreased psychological distress ( primary outcome ) , fewer unmet needs and increased levels of perceived preparedness , competence and positive emotions . METHODS A three-arm r and omised controlled trial was conducted comparing two versions of the intervention ( one face-to-face visit versus two visits ) plus st and ard care to a control group ( st and ard care ) across four sites in Australia . RESULTS A total of 298 participants were recruited ; 148 were in the Control condition , 57 in Intervention 1 ( one visit ) and 93 in Intervention 2 ( two visits ) . Relative to participants in the control group ; the psychological well-being of participants in the intervention condition was improved by a small amount but non-significantly . No significant reduction in unmet needs or improvements in positive aspects of caregiving amongst the intervention group were identified . However , the intervention demonstrated significant improvements in participants ' levels of preparedness and competence for Intervention 2 . CONCLUSION / IMPLICATION S This research adds to accumulating body of evidence demonstrating that relatively short psycho-educational interventions can enable family caregivers to feel more prepared and competent in the role of supporting a dying relative . Further investigation is required to determine the longer term outcomes of such interventions OBJECTIVE Informal caregivers ( family and friends ) of people with cancer are often unprepared for their caregiving role , leading to increased burden or distress .  Comprehensive Health Enhancement Support System ( CHESS ) is a Web-based lung cancer information , communication , and coaching system for caregivers . This r and omized trial reports the impact on  caregiver burden , disruptiveness , and mood of providing caregivers access to CHESS versus the Internet with a list of recommended lung cancer websites . METHODS A total of 285 informal caregivers of patients with advanced nonsmall cell lung cancer were r and omly assigned to a comparison group that received Internet or a treatment group that received Internet and CHESS . Caregivers were provided a computer and Internet service if needed . Written surveys were completed at pretest and during the intervention period bimonthly for up to 24 months . Analyses of covariance ( ANCOVAs ) compared the intervention 's effect on caregivers ' disruptiveness and burden ( CQOLI-C ) , and negative mood ( combined Anxiety , Depression , and Anger scales of the POMS ) at 6 months , controlling for blocking variables ( site , caregiver 's race , and relationship to patient ) and the given outcome at pretest . RESULTS Caregivers r and omized to CHESS reported lower burden , t(84 ) = 2.36 , p = .021 , d = .39 , and negative mood , t(86 ) = 2.82 , p = .006 , d = .44 , than those in the Internet group . The effect on disruptiveness was not significant . CONCLUSIONS Although caring for someone with a terminal illness will always exact a toll on caregivers , eHealth interventions like CHESS may improve caregivers ' underst and ing and coping skills and , as a result , ease their burden and mood People caring for palliative patients at home identify respite care as a key need . However , caregiver concern over the skill level of respite care providers has been cited as a common barrier to uptake and satisfaction with respite services . This study implemented and evaluated an  at-home palliative care respite service delivered by enrolled nurses , known by various names in the UK . It was found that the program reduced hospitalizations of palliative patients  by 80 % and potentially increased the likelihood that they would die at home BACKGROUND Family caregivers in cancer and palliative care often face heavy responsibilities and feel insufficiently prepared for the situation as caregivers . This study evaluates short-term and long-term effects of a psycho-educational group intervention aim ing to increase preparedness for family caregiving in specialized palliative home care . METHODS The study design was a r and omized control trial where family caregivers were allocated either to an intervention or control group . The intervention was delivered as a program including three sessions by health professionals ( physician , nurse , and social worker/priest ) . Family caregivers from 10 specialized palliative home care setting s were included . Question naires with vali date d instruments at baseline , upon completion , and 2 months following the intervention were used to measure effects of the intervention . The primary outcome was preparedness for caregiving in family caregivers . RESULTS In total , 21 intervention programs were delivered , and 119 family caregivers completed all three measurements . The intervention group had significantly increased their preparedness for caregiving in both the short-term and long-term follow-up compared with the control group . The intervention group also reported significantly increased competence for caregiving in short-term but not long . No effects of the intervention were found on rewards for caregiving , caregiver burden , health , anxiety , or depression . CONCLUSIONS The psycho-educational intervention has the potential to be used by health professionals to improve preparedness for caregiving among family caregivers in palliative care both in short and long terms . Copyright © 2015 John Wiley & Sons , Ltd. Copyright © 2015 John Wiley & Sons , Family caregivers of patients enrolled in home-based palliative care programmes  provide unpaid care and assistance with daily activities to terminally ill family members . Caregivers often experience caregiver burden , which is an important predictor of anxiety and depression that can extend into bereavement . We conducted a longitudinal , prospect i ve cohort study to comprehensively assess modifiable and non-modifiable patient and caregiver factors that account for caregiver burden over the palliative care trajectory . Caregivers ( n = 327 ) of patients with malignant neoplasm were recruited from two dedicated home-based palliative care programmes in Southern Ontario , Canada from 1 July 2010 to 31 August 2012 . Data were obtained from bi-weekly telephone interviews with caregivers from study admission until death , and from palliative care programme and home-care agency data bases . Information collected comprised patient and caregiver demographics , utilisation of privately and publicly financed re sources , patient clinical status and caregiver burden . The average age of the caregivers was 59.0 years ( SD : 13.2 ) , and almost 70 % were female .  Caregiver burden increased over time in a non-linear fashion from study admission to patient death . Increased monthly unpaid care-giving time costs , monthly public personal support worker costs , emergency department visits and low patient functional status were associated with higher caregiver burden . Greater use of hospice care was associated with lower burden .  Female caregivers tended to report more burden compared to men as death approached , and burden was higher when patients were male . Low patient functional status was the strongest predictor of burden . Underst and ing the influence of modifiable and non-modifiable factors on the experience of burden over the palliative trajectory is essential for the development and targeting of programmes and policies to support family caregivers and reduce burden . Supporting caregivers can have benefits such as improved caregiver health outcomes , and enhancing their ability to meet care-giving dem and s , thereby potentially allowing for longer patient care in the home setting
OBJECTIVE To examine the characteristics of interventions to support family caregivers of patients with advanced cancer .