br Conclusions Recommendations for the development of effect
Conclusions: Recommendations for the development of effective intervention programs are
offered: increasing the psychological services provided in oncology units, training medical
* Corresponding author. Departamento de Neuropsicobiologı´a, Metodologı´a y Psicologı´a Social Universidad Catolica de Valencia, C/
E-mail addresses: [email protected] (M.D. Bonacasa), [email protected] (E. Rosa), [email protected] (C. Camps), david.
[email protected] (D. Martı´nez-Rubio).
staff in communication skills, facilitating access to information about the disease through different means, training for informal caregivers in care techniques, coping and commu-nication skills, self-care, and organization of time. On the one hand, implementing effec-tive intervention programs for informal caregivers will reduce the amount withdrawing from their care duties and on the other hand, the proliferation of what are known as secondary patients.
© 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Despite the significant advances made in cancer treatment, this ABT-888 (Veliparib) disease is one of the leading causes of death in devel-oped countries.1 The advanced stages of this disease are characterized by intense suffering and a high need for care. At this point, the family becomes particularly important. In most cases, relatives become informal caregivers owing to the demands produced by the disease itself or by the pa-tient's treatment. Carers should address a wide range of is-sues, including the following: physical problems (such as pain, fatigue, or insomnia), emotional problems (such as anxiety or depression), and problems of a practical nature (such as financial or legal difficulties). However, the care-giver's needs are largely unmet,2e5 which can considerably worsen the intense emotional climate produced by the impact of the disease and the anticipation of the loss of a loved one.6
Some empirical studies reveal that informal caregivers of patients with end-stage cancer have greater anxiety and symptoms of depression than the patients themselves, which affects their quality of life.7e9 The findings of these studies suggest that main caregivers should not be treated merely as care partners but also as possible secondary and future pa-tients. In addition, informal caregivers also manifest different needs at the physical, social, and psychological levels (e.g., see10e13). A recent review5 classified the unmet needs of partners and caregivers of adults diagnosed with cancer into six categories: comprehensive cancer care, emotional and psychological, partner or caregiver impact and daily activities, relationship, information, and spiritual needs. They found that the main unmet needs across a number of studies included managing their own and the patient's emotional distress and, consequently, the need for specific training in coping skills. Regarding information needs, Adams et al.14 carried out a systematic review of empirical studies that assessed these needs in partners and/or family members of adult patients with cancer. They found that most of the studies focused on the diagnosis and initial treatment phase but did not assess the needs of the more advanced phases of the disease. Moreover, only some of them distinguished be-tween met and unmet needs, concluding that caregivers were more likely to have unmet needs for information about sup-portive care than for medical information.
As a recent meta-analysis pointed out, although in-terventions have small to medium effects, they significantly relieve the burden and improve coping skills, self-efficacy,
and quality of life.15 More specifically, a systematic review of community intervention models for dependent people and their caregivers concluded that some respite care positively affects caregivers' physical and mental health while lowering their perceived burden.16 Types of services studied included the following: day care, host family, in-home, institutional, and video respite. The formal health support services are also called respite services because their purpose is to relieve the caregiver, on a regular or temporary basis, of responsibility and caregiving demands. Clearly, it is important to act early to improve the quality of life of informal caregivers because unmet needs not only compromize caregivers' quality of life but also have an adverse effect on the quality of care provided to patients.3,17