Rossi Ferrario Silvia, Cardillo Venerando, Vicario Franco, Balzarini Elena, Zotti Anna Maria
Psychology Unit, S Maugeri Foundation, IRCCS, Scientific Institute of Veruno (NO), Italy.
Palliat Med. 2004 Mar;18(2):129-36. doi: 10.1191/0269216304pm870oa.
The advanced and terminal phases of cancer are being increasingly treated at home with the aid of palliative care teams. It is well known that caregivers are overburdened emotionally, financially and physically, and some studies have demonstrated that this overload extends beyond the period of mourning. Identifying caregivers at risk of bereavement maladjustment is a useful means of ensuring prompt psychological and social assistance, and optimising the available resources.
One hundred and eleven caregivers of home-treated patients with advanced/terminal cancer were recruited by the palliative care unit operating in their place of residence. After giving their informed consent, all of the caregivers were asked to complete questionnaires designed to evaluate various emotional, financial and social aspects. Three, six and 12 months after the decease of their patients, the caregivers were contacted again and asked to complete other questionnaires aimed at assessing their emotional reactions and bereavement-related problems.
The 12-month follow-up was completed by 93 caregivers. Their bereavement maladjustment problems correlated with their perception of emotional distress and the caregiving-related problems detected at the time of referral, particularly among females. Spouses, subjects aged over 61 years and those perceiving a substantial emotional burden proved to be at greater long-term risk.
The identification of overburdened caregivers and those at risk of long-term bereavement maladjustment may facilitate the programming of ad hoc interventions that could reduce inherent health and social costs. Palliative care teams can usefully include someone to identify such caregivers by means of inexpensive and objectively predictive instruments.
癌症晚期和终末期越来越多地在姑息治疗团队的帮助下在家中接受治疗。众所周知，照顾者在情感、经济和身体上负担过重，一些研究表明，这种负担在哀悼期之后仍会持续。识别有丧亲适应不良风险的照顾者是确保及时提供心理和社会援助以及优化可用资源的有效手段。
在其居住地开展工作的姑息治疗科招募了111名在家中接受治疗的晚期/终末期癌症患者的照顾者。在获得他们的知情同意后，要求所有照顾者填写旨在评估各种情感、经济和社会方面的问卷。在其患者去世后的3个月、6个月和12个月，再次联系照顾者，要求他们填写其他问卷，以评估他们的情绪反应和与丧亲相关的问题。
93名照顾者完成了12个月的随访。他们的丧亲适应不良问题与他们在转诊时所感受到的情感困扰以及与照顾相关的问题有关，尤其是在女性中。配偶、61岁以上的人以及那些感到有很大情感负担的人被证明长期风险更大。
识别负担过重的照顾者以及有长期丧亲适应不良风险的人可能有助于制定特别干预措施，从而降低内在的健康和社会成本。姑息治疗团队可以有效地安排专人通过廉价且客观的预测工具来识别此类照顾者。
