Lim, H.A., Griva, K., Yoong, R.K., Chua, J., Leow, M.Q., Chan, M.F., . . . Mahendran, R. (2015). Do caregivers of cancer patients receiving care in home hospice services have better quality of life? An exploratory investigation in Singapore. Psycho-Oncology, 25, 471–474. 

To examine the differences between caregiver quality of life when caring for a patient in a home hospice program and an ambulatory patient receiving formal palliative care program services

Governmentally supported home hospice services provided to patients with advanced cancer by a multidisciplinary team

• N = 258   
• MEDIAN AGE = 41–50 years
• MALES: 33%, FEMALES: 67%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Patients with advanced (stage III/IV) mixed cancer diagnoses and expected to live at least three months 
• OTHER KEY SAMPLE CHARACTERISTICS: Caregivers had to be aged at least 21 years and able to communicate in either Mandarin or English 

• SITE: Multi-site   
• SETTING TYPE: Multiple settings    
• LOCATION: Singapore

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care 

Cross-sectional study with combined data from two studies

• Caregiver Quality of Life Index-Cancer (CQOLC)
• Domain-specific and validated in both ambulatory and hospice care settings

Significant Pearson intercorrelations (rs = 0.18-0.84, ps < 0.05) for CQOLC total scores and subscales excluding positive adaptation and disruptiveness subscales were found. Males had significantly lower total CQOLC scores (p = 0.012) and disruptiveness scores (p = 0.003). Significantly lower CQOLC scores also resulted in caregivers caring for parents (and tertiary education [all values = p < 0.05]). Chinese ethnic caregivers had better QOL related to burden (p = 0.031) and financial concerns (p = 0.024), but less successful positive adaptation resulted in lower QOL (p = 0.024). Although data analysis controlled for significant differences in age and spousal caregiving, ambulatory patient caregivers were older and more likely to be spousal caregivers. Analysis of covariance (ANCOVA) supported home hospice caregivers experiencing better QOL than ambulatory patient caregivers but only in total CQOLC scores (p = 0.008) and subscales of financial worries and burden (p = 0.004).

Home hospice care programs for patients with palliative cancer care needs appear to benefit caregiver QOL, particularly in minimizing perceptions of burden and financial concerns. Those programs, composed of multidisciplinary teams focused on responding to patient end-of-life needs, seem to improve caregiver confidence in care and satisfy caregivers’ desire for personalized support by healthcare providers.

• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results
• Lack of control on potential study confounding variables; study focus on Chinese caregivers only, so data findings cannot be generalizable.

Models of home hospice services to mutually benefit caregivers and those they care for need further testing in a variety of cultures with variant healthcare systems to more clearly validate the efficiency of and benefits of those models in meeting caregiver improved QOL.