Hostname: page-component-7c8c6479df-94d59 Total loading time: 0 Render date: 2024-03-28T17:37:49.729Z Has data issue: false hasContentIssue false

Association between the emotional status of family caregivers and length of stay in a palliative care unit: A retrospective study

Published online by Cambridge University Press:  11 June 2015

Seon Hee Kim
Affiliation:
Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
In Cheol Hwang*
Affiliation:
Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea Palliative Care Unit, Incheon Regional Cancer Center, Incheon, Korea
Ki Dong Ko
Affiliation:
Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
Young Eun Kwon
Affiliation:
Palliative Care Unit, Incheon Regional Cancer Center, Incheon, Korea
Hong Yup Ahn
Affiliation:
Department of Statistics, Dongguk University, Seoul, Korea
Nan Young Cho
Affiliation:
Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
Seung Jin Kim
Affiliation:
Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
*
Address correspondence and reprint requests to: In Cheol Hwang, Department of Family Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, South Korea. E-mail: spfe0211@gmail.com.

Abstract

Objective:

Several factors associated with referral time to hospice and/or palliative care services have been identified, but there is no literature on the association between these services and the emotional status of the family caregivers (FCs). This article is intended to address that issue.

Method:

A semistructured interview was employed to collect data for a retrospective cohort study. The primary FCs of terminally ill cancer patients were interviewed at the time of the patient's referral to the palliative care unit. Interview data were combined with patients' medical record data for our analysis. The emotional status of the FCs was categorized into one of three groups according to their responses to the anticipated death of their family member: acceptance, anxious/depressed, and denial/angry. A Cox proportional hazard model was used to examine and identify the factors related to the length of stay (LOS) in the palliative care unit.

Results:

A total of 198 patient–FC pairs were identified. The median LOS was 18 days. A multivariate analysis with adjustment for potential variables revealed significant differences in LOS according to cancer type and time since cancer diagnosis. The denial/angry FC category was independently associated with a shorter LOS (vs. acceptance, adjusted hazard ratio (aHR) 2.11; 95% confidence interval (CI), 1.11–4.03).

Significance of Results:

We found that terminally ill cancer patients who were referred late had FCs who were in denial or were angry about the anticipated death of their loved one. The emotional status of FCs should be considered when patients with terminal cancer are referred to palliative care.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Awadalla, A.W., Ohaeri, J.U., Gholoum, A., et al. (2007). Factors associated with quality of life of outpatients with breast cancer and gynecologic cancers and their family caregivers: A controlled study. BMC Cancer, 7, 102.Google Scholar
Baek, Y.J., Shin, D.W., Choi, J.Y., et al. (2011). Late referral to palliative care services in Korea. Journal of Pain and Symptom Management, 41(4), 692699.Google Scholar
Bakitas, M., Lyons, K.D., Hegel, M.T., et al. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. The Journal of the American Medical Association, 302(7), 741749.CrossRefGoogle Scholar
Bevans, M. & Sternberg, E.M. (2012). Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. The Journal of the American Medical Association, 307(4), 398403.CrossRefGoogle ScholarPubMed
Bruera, E. & Hui, D. (2010). Integrating supportive and palliative care in the trajectory of cancer: Establishing goals and models of care. Journal of Clinical Oncology, 28(25), 40134017.Google Scholar
Casarett, D.J. & Quill, T.E. (2007). “I'm not ready for hospice”: Strategies for timely and effective hospice discussions. Annals of Internal Medicine, 146(6), 443449.Google Scholar
Christakis, N.A. (1994). Timing of referral of terminally ill patients to an outpatient hospice. Journal of General Internal Medicine, 9(6), 314-320.Google Scholar
Christakis, N.A. & Escarce, J.J. (1996). Survival of Medicare patients after enrollment in hospice programs. The New England Journal of Medicine, 335(3), 172178.Google Scholar
Christakis, N.A. & Lamont, E.B. (2000). Extent and determinants of error in doctors' prognoses in terminally ill patients: Prospective cohort study. BMJ, 320(7233), 469472.Google Scholar
Daugherty, C.K. & Steensma, D.P. (2002). Overcoming obstacles to hospice care: An ethical examination of inertia and inaction. Journal of Clinical Oncology, 20(11), 27522755.Google Scholar
Earle, C.C., Park, E.R., Lai, B., et al. (2003). Identifying potential indicators of the quality of end-of-life cancer care from administrative data. Journal of Clinical Oncology, 21(6), 11331138.Google Scholar
Gazelle, G. (2007). Understanding hospice: An underutilized option for life's final chapter. The New England Journal of Medicine, 357(4), 321324.Google Scholar
Greer, J.A., Jackson, V.A., Meier, D.E., et al. (2013). Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA: A Cancer Journal for Clinicians, 63(5), 349363.Google Scholar
Hodges, L.J., Humphris, G.M. & Macfarlane, G. (2005). A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Social Science & Medicine, 60(1), 112.Google Scholar
Hui, D., Elsayem, A., de la Cruz, M., et al. (2010). Availability and integration of palliative care at U.S. cancer centers. The Journal of the American Medical Association, 303(11), 10541061.Google Scholar
Kübler-Ross, E. (1969). On death and dying. London, New York: Macmillan.Google Scholar
Kapo, J., Harrold, J., Carroll, J.T., et al. (2005). Are we referring patients to hospice too late? Patients' and families' opinions. Journal of Palliative Medicine, 8(3), 521527.Google Scholar
Keating, N.L., Landrum, M.B., Rogers, S.O. Jr., et al. (2010). Physician factors associated with discussions about end-of-life care. Cancer, 116(4), 9981006.Google Scholar
Kwak, J. & Salmon, J.R. (2007). Attitudes and preferences of Korean-American older adults and caregivers on end-of-life care. Journal of the American Geriatric Society, 55(11), 18671872.Google Scholar
Kwon, Y.C., Shin, D.W., Lee, J.H., et al. (2009). Impact of perception of socioeconomic burden on advocacy for patient autonomy in end-of-life decision making: A study of societal attitudes. Palliative Medicine, 23(1), 8794.Google Scholar
Lamont, E.B. & Christakis, N.A. (2002). Physician factors in the timing of cancer patient referral to hospice palliative care. Cancer, 94(10), 27332737.CrossRefGoogle ScholarPubMed
Lau, F., Downing, G.M., Lesperance, M., et al. (2006). Use of the Palliative Performance Scale in end-of-life prognostication. Journal of Palliative Medicine, 9(5), 10661075.CrossRefGoogle ScholarPubMed
Lee, Y.J., Yang, J.H., Lee, J.W., et al. (2014). Association between the duration of palliative care service and survival in terminal cancer patients. Supportive Care in Cancer, 23(4), 10571062.Google Scholar
McCarthy, E.P., Burns, R.B., Ngo-Metzger, Q., et al. (2003). Hospice use among Medicare managed care and fee-for-service patients dying with cancer. The Journal of the American Medical Association, 289(17), 22382245.Google Scholar
Phipps, E., True, G., Harris, D., et al. (2003). Approaching the end of life: Attitudes, preferences, and behaviors of African-American and white patients and their family caregivers. Journal of Clinical Oncology, 21(3), 549554.CrossRefGoogle ScholarPubMed
Rickerson, E., Harrold, J., Kapo, J., et al. (2005). Timing of hospice referral and families' perceptions of services: Are earlier hospice referrals better? Journal of the American Geriatric Society, 53(5), 819823.Google Scholar
Rodriguez, K.L., Barnato, A.E. & Arnold, R.M. (2007). Perceptions and utilization of palliative care services in acute care hospitals. Journal of Palliative Medicine, 10(1), 99110.Google Scholar
Sonnenblick, M., Friedlander, Y. & Steinberg, A. (1993). Dissociation between the wishes of terminally ill parents and decisions by their offspring. Journal of the American Geriatric Society, 41(6), 599604.CrossRefGoogle ScholarPubMed
Stillman, M.J. & Syrjala, K.L. (1999). Differences in physician access patterns to hospice care. Journal of Pain and Symptom Management, 17(3), 157163.Google Scholar
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733742.Google Scholar
Vig, E.K., Starks, H., Taylor, J.S., et al. (2010). Why don't patients enroll in hospice? Can we do anything about it? Journal of General Internal Medicine, 25(10), 10091019.Google Scholar
Waldrop, D.P. (2006). At the eleventh hour: psychosocial dynamics in short hospice stays. The Gerontologist, 46(1), 106114.Google Scholar
Waldrop, D.P. & Rinfrette, E.S. (2009). Can short hospice enrollment be long enough? Comparing the perspectives of hospice professionals and family caregivers. Palliative & Supportive Care, 7(1), 3747.Google Scholar
Younis, T., Milch, R., Abul-Khoudoud, N., et al. (2007). Length of survival of patients with cancer in hospice: A retrospective analysis of patients treated at a major cancer center versus other practice settings. Journal of Palliative Medicine, 10(2), 381389.CrossRefGoogle Scholar
Younis, T., Milch, R., Abul-Khoudoud, N., et al. (2009). Length of survival in hospice for cancer patients referred from a comprehensive cancer center. The American Journal of Hospice & Palliative Care, 26(4), 281287.Google Scholar
Yun, Y.H., Han, K.H., Park, S., et al. (2011). Attitudes of cancer patients, family caregivers, oncologists and members of the general public toward critical interventions at the end of life of terminally ill patients. CMAJ, 183(10), E673E679.Google Scholar
Zimmermann, C. (2012). Acceptance of dying: A discourse analysis of palliative care literature. Social Science & Medicine, 75(1), 217224.Google Scholar