Hudson, P., Quinn, K., Kristjanson, L., Thomas, T., Braithwaite, M., Fisher, J., & Cockayne, M. (2008). Evaluation of a psycho-educational group programme for family caregivers in home-based palliative care. Palliative Medicine, 22, 270–280.

To develop, implement, and evaluate a group education program to prepare family caregivers who assume primary care for a relative/friend receiving home-based palliative care

Participants attended three group educational sessions (1.5 hours each) held over a three-week period in one of six palliative care service settings. Educational sessions involved education on the caregiver role, identification of palliative care services, strategies for responding to patient needs, strategies to maintain caregiver well-being, and specific content related to preparing for death and dying care. Evaluation of the intervention included participant completion of seven validated instruments (producing nine outcomes) before program commencement, following program completion, and two weeks following the program. Qualitative assessments also occurred via semistructured interviews with at least one participant per program (16) within two weeks of program completion and via facilitator journals to reflect perceptions of the program.

• The sample included 44 participants.   
• Mean age was 59.8 years, with a range of 39–84 years.
• The sample was 25% male and 75% female.
• Of the patients, 96% had cancer and 30% had been recently hospitalized; other information about patient disease characteristics is unknown.
• Of the caregivers, 43% had less than high school education and most worked outside the home. Most caregivers believed their health to be moderately good, had limited financial concerns, and overwhelmingly served as caregivers predominately to their spouse or child because they “wanted to be.”

• Multisite  
• Home setting
• Rural and urban care services in Australia

• End-of-life care phase
• Elder care, palliative care

A quasi-experimental, time-series design was used.

• Caregiver Competence Scale
• Preparedness for Caregiving Scale
• Family Inventory of Need
• Rewards for Caregiving Scale
• Social Support Questionnaire
• Brief Assessment Scale for Caregivers
• Life Orientation Test

A repeated measures analysis of variance on all nine variables over three testing times found multivariate effects for time (p < 0.001), including moderate associations between time and combined dependent variables (effect size by eta² = 0.36). The intervention had significant effects (p < 0.01 or better) on caregiver preparedness, perceptions of rewards, competence, and having needs met, and this effect was sustained up to two weeks post-program. Caregiver burden showed a significant (p < 0.001) increase between time 2 (post-program) and time 3 (two weeks post-program) of assessment, a finding perhaps related to poor patient prognosis. Social support and optimism levels appeared stable. Qualitative findings demonstrated overall favorable program feedback and appreciation of practical advice on available resources and symptom management provided.

This study found that a conceptually based psychoeducational group intervention for caregivers caring for a dying patient had some positive effects on caregiver preparedness, competence, rewards, and unmet needs. However, the program did not improve caregiver optimism, burden, or social support.

• The sample was small, with less than 100 participants.
• Risk of bias existed due to no control group and sample characteristics.*
• The study findings are not generalizable.*
• Subject withdrawals were ≥ 10%.
• Other limitations/*explanation: The study had substantial incomplete data, with only 59% of the sample completing all study measures.

Findings from this study continue to support the need for oncology nurses to assess and intervene with evidence-based programs focused on meeting the needs of caregivers of terminally ill patients. Results did not show an effect of the intervention to reduce caregiver burden; however, qualitative results desmonstrated caregiver appreciation of information on available resources and symptom management, pointing to the value of provision of this type of information to caregivers.