PSYCHOSOCIAL PROBLEMS AND COPING STRATEGIES AMONG THE CAREGIVERS OF CANCER PATIENTS IN PALLIATIVE CARE: A SYSTEMATIC REVIEW

Abstract

This is a review of 50 studies which have looked at the psychosocial problems, burden of care, coping and support needs of the carers of people with cancer with a particular emphasis on advanced cancer and palliative care. The studies included qualitative, quantitative, mixed methods, longitudinal, cross-sectional, scoping reviews, systematic reviews and meta-analyses. Across the studies there was a consistent finding that carers were at risk of experiencing psychological distress, anxiety, depressive symptoms, stress, fatigue, sleep disturbance, grief and guilt, social isolation, financial strain, disruption to work, change in family roles and reduced quality of life. The longer the period of care and the more dependent the patient was, the greater the burden of care. The burden of care was also linked to the need for symptom management, lack of information and poor access to professional support. The most commonly reported adaptive coping strategies were acceptance, active and problem focused coping, positive reframing, planning, emotional and instrumental support, spiritual or religious coping and information seeking. Avoidance, denial, behavioural disengagement and self-blame were all associated with worse psychological outcomes or greater burden in a number of the studies. The intervention research suggests that psychoeducation, counselling, support groups, stress management and family and carer centred palliative care services may all be of benefit to carers. The findings clearly indicate that carers should be viewed as individuals with their own health and support needs rather than as simply an extension of patient care.