Adverse—and even positive—outcomes in a chronic stress experience.

Adverse-and even positive-outcomes in a chronic stress experience.The associations between physical and psychological health and being an informal caregiver are well established. 1,7 In this article, caregiving denotes care that is provided by a family member or friend rather than by a professional who is reimbursed for services.Clinical observation and early empirical research showed that assuming a caregiving role can be stressful and burdensome. 8,9 Caregiving has all the features of a chronic stress experience: It creates physical and psychological strain over extended periods of time, is accompanied by high levels of unpredictability and uncontrollability, has the capacity to create secondary stress in multiple life domains such as work and family relationships, and frequently requires high levels of vigilance. Caregiving fits the formula for chronic stress so well that it is used as a model for studying the health effects of chronic stress. 2

Purpose/Objectives-The purpose of the study was to examine the patient and family caregiver variables that predicted caregiver burden and depression for family caregivers of patients with cancer at the end-of-life.Design-A prospective, longitudinal study was implemented with an inception cohort of patients and their family caregivers who were followed after the diagnosis and treatment of cancer. Data were analyzed using quantitative methods to determine the effect of caregiver age, sex, education, relationship to the patient, employment status, reports of patients' symptoms, patient cancer type, stage of cancer, and time from the patient's diagnosis to death on caregiver burden and depression at the patient's end-of-life. This report examines the experiences of family caregivers whose patients died during the study. Setting-Patients and caregivers were accrued from community oncology sites in the Midwestern United States.Sample-152 family caregivers of patients with cancer who died during the course of the study.Methods-Telephone interviews with patients were conducted at 6-8 weeks, 12-16 weeks, 24-30 weeks, and 52 weeks following patients' diagnoses. In addition, patient medical records and state death certificates were reviewed.Findings-Caregivers aged 45-54 reported the highest levels of depressive symptoms; caregivers aged 35-44 reported the strongest sense of abandonment. Caregivers who were the adult children of patients with cancer and who were employed reported high levels of depressive symptoms. Feeling abandoned (a portion of caregiver burden) was more prevalent in female, non-spouse, and adult

Although investigators have identified rewards and difficulties from assuming the role of caregiver for persons with cancer and persons with Alzheimer's disease, few studies have examined factors that lead to role strain for caregivers of persons with both oncological and neurological symptoms. In this study qualitative methods were used to analyse data from self-report questionnaires from 43 caregivers of adults with a primary malignant brain tumour (PMBT) in the USA. Six themes emerged from the analysis: the work of caring, informal support, formal support, information, dealing with symptoms, and end of life. The data suggest that health-care providers (HCPs) may decrease role strain by helping to identify competing demands, clarifying expectations of the role, providing information to caregivers on how to use formal and informal support systems to delegate care tasks, and by teaching caregivers how and when to ask for help. HCPs may also assist caregivers by providing information on managing cognitive and neuropsychiatric problems at home, what to expect at the end of life, and by following up to determine the caregiver's ability to integrate information into providing care.

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