Levels, types, and predictors of family caregiver strain during hospice home care for an older adult.

Academic researchers and professionals from a hospice organization collaborated to assess physical, emotional, social, economic, and spiritual strain stemming from providing care to a terminally ill older relative among 162 family caregivers to older adults newly admitted to hospice home care. The study investigated predictors of the different types of strain, as well as cumulative strain. Hierarchical multiple regressions revealed that caregivers' age and race, hospice patients' major illnesses (particularly cancer), caregivers' appraisals of their situation, and resources were significant risk or protective factors for caregiver strain, although the predictors varied by type of strain and amount of strain. Discussion focuses on the importance of identifying family caregivers at risk of higher strain during hospice home care and implications for family caregiver interventions.

The effects of integrating an advanced practice palliative care nurse in a community oncology center: a pilot study.

Despite the widespread recognition of the need for new models of care to better serve patients with advanced cancer, little evidence exists to document the effectiveness of these models. The purpose of this pilot study was to investigate the integration of an on-site palliative care (PC) advanced practice nurse (APRN) in the community oncology setting and the effect of PC services on patients with advanced cancer compared with usual care. This study utilized a descriptive, pre/post design with 101 adult patients with advanced cancer. Patient accrual occurred for 5 months in the usual care period (n=52), followed by 5 months of accrual after implementation of the PC APRN (n=49). Data were collected at enrollment and 4 months post enrollment. Data were analyzed using independent t-tests and logistic regression analyses. Controlling for health-related quality-of-life variables, 10 covariates were entered into two logistic regression models, with hospitalization and mortality as outcome measures. Patients who had palliative care had a significantly lower mortality rate at 4 months (odds ratio = 24.6; P = 0.02) and had an 84% decrease in the odds of being hospitalized (odds ratio = 0.16; P < 0.01). Contrary to popular belief, PC services can be effectively provided to patients as they receive chemotherapy treatment and are not associated with increased mortality. Access to a PC APRN integrated into the community oncology setting may be associated with measurable benefits.

The FACES Project: an academic-community partnership to improve end-of-life care for families.

This article reports on a research partnership between a community-based hospice and a graduate school of social work. The purpose of the collaboration was to design and test a tool for assessing caregiver strain and resources in families caring for older adults receiving hospice home care services. Eighteen hospice home care social workers interviewed 162 caregivers for the study and provided their own assessment of the tool's clinical utility. Both strengths and challenges of the collaboration are evaluated and implications are discussed for social work practice and research, particularly academic-community research partnerships.