Objective: Family members who take on the role of caregiving for someone who is dying begin bereavement after being emotionally and physically taxed by the caregiving experience. The course of bereavement is influenced by a number of factors, including health problems, financial concerns, social support, and family relationships. This paper reports on findings from a secondary analysis of qualitative data from a study examining family caregiver coping in end-oflife cancer care, to describe, from the perspectives of bereaved family caregivers, their perspectives on what made their grief difficult.Method: Qualitative data from three focus groups with family caregivers (n ¼ 19) and two focus groups with health professionals (n ¼ 14) were subjected to interpretive thematic analysis.Results: Our finding suggest three broad areas that make family caregivers' grief difficult: (1) dealing with occurrences in everyday life; (2) dealing with challenges specific to the caregiving situation; and (3) dealing with the healthcare system.Significance of results: The findings provide an important beginning point in understanding the types of issues that seem to make grief difficult for family caregivers of cancer patients at the end of life and can help professional groups to understand what is needed by family caregivers in terms of support and delivery of services.

Ethical and practical issues are sure to arise from the majority of research studies done with palliative populations. Whether it is feeling opportunistic, being emotionally available, or struggling with witnessing a gap in service and needs of the participants receiving care, nurses involved in research find a way to balance both roles to meet the needs of the participants as well as the study (McIlfatrick, Sullivan, & McKenna, 2006 Caring (1991).Nursing is a wide-ranging profession offering the opportunity for a variety of roles in a multitude of settings. In 2005, nearly 75% of Canadian nurses were employed in direct patient care and 0.7% in research as their primary area of responsibility (Canadian Institute for Health Information [CIHI], 2006). Nurses involved in direct patient care have a particular knowledge and way of being with patients and families that makes them a great asset for researchers in assisting with data collection. However, involvement in research places these nurses in a position of having two roles -that of frontline practising nurse and that of nurse involved in doing research (Colbourne & Sque, 2004). Concerns often arise around the sometimes conflicting obligations of balancing the sensitivities and vulnerabilities of participants, while at the same time attempting to adhere to issues of study rigor (Daly & Rosenfeld, 2003). This paper highlights some of the ethical and practical issues that arise when nurses take on the dual roles of clinician and researcher, especially with end-of-life populations. The authors discuss this "balancing act" and offer recommendations on how to approach and be with people when doing research at the end of life. Swanson's middle range theory of caring (1991) provides a framework for the discussions. Setting the contextThe authors of this paper were brought together when they were hired to work on a multi-site research project funded by the Canadian Cancer Society entitled, "Family Caregiver Coping in End-of-Life Cancer Care." The project was led by a nurse researcher (K.S.), coordinated by a Master's prepared nurse (W.M.) and comprised several research assistants, five of whom were registered nurses (RNs) and who were responsible for conducting in-depth semistructured interviews and administering a structured questionnaire to a sample of family caregivers of people who were dying of cancer. The primary purpose of the study was concerned with the question of why some caregivers seem to cope better than others while under similar caregiving demands. The research assistants were not directly involved with the care of the dying family member, but were working in home nursing care or cancer care, having experience and expertise with the population being studied. The research participants were recruited through hospice, homecare, and pain and symptom management clinics in three urban areas in British Columbia. Qualitative interviews were done with 28 current caregivers and 17 bereaved caregivers. More than 300 family caregivers participated in the qua...

Abrégé ContexteLes auteures de cet article se sont connues lorsqu'elles ont été embauchées pour travailler dans un projet de recherche à sites multiples subventionné par la Société canadienne du cancer et baptisé « Aidants naturels face à des soins de fin de vie liés au cancer ». Le projet était dirigé par une infirmière chercheuse (K.S.), était coordonné par une infirmière titulaire d'une maîtrise (W.M.) et regroupait plusieurs assistantes de recherche, dont cinq étaient des infirmières qui ont été chargées de réaliser des entrevues semi-structurées approfondies et d'administrer un questionnaire structuré à un échantillon d'aidants naturels dont un proche était en train de mourir du cancer. L'objectif principal de l'étude consistait à déterminer la raison pour laquelle certains aidants naturels semblent mieux s'adapter que d'autres à des situations semblables. Les assistantes de recherche ne contribuaient pas directement à la prestation de soins aux patients mourants, mais oeuvraient dans le domaine des soins infirmiers à domicile ou en oncologie. Elles possédaient une expérience et un savoir-faire spécialisés auprès de la population cible. On a recruté les participants à l'étude dans des centres de soins palliatifs, des programmes de soins à domicile et des cliniques de gestion de la douleur et des symptômes dans trois centres urbains de la Colombie-Britannique. On a réalisé des entrevues qualitatives auprès de 28 aidants actuels et de 17 aidants en deuil. Plus de 300 aidants naturels ont participé à la phase quantitative de l'étude. Bon nombre des assistantes de recherche avaient une formation de recherche formelle limitée; afin de les préparer au projet, la chercheuse principale leur a offert deux séances de formation d'une journée complète chacune. La formation couvrait des sujets comme