Part 1: Home-based family caregiving at the end of life: a comprehensive review of published quantitative research (1998-2008)

The changing context of palliative care over the last decade highlights the importance of recent research on home-based family caregiving at the end of life. This article reports on a comprehensive review of quantitative research (1998—2008) in this area, utilizing a systematic approach targeting studies on family caregivers, home settings, and an identified palliative phase of care (n = 129). Methodological challenges were identified, including: small, non-random, convenience samples; reliance on descriptive and bivariate analyses; and a dearth of longitudinal research. Robust evidence regarding causal relationships between predictor variables and carer outcomes is lacking. Findings suggest the need for knowledge regarding: family caregiving for patients with non-malignant terminal conditions; whether needs and outcomes differ between family caregivers at the end of life and comparison groups; and caregiver outcomes in bereavement. Clear definitions of ‘family caregiving’, ‘end of life’, and ‘needs’ are required as well as greater application and testing of theoretical and conceptual explanations.

[1]  J. Teno,et al.  Family evaluation of hospice care: results from voluntary submission of data via website. , 2005, Journal of pain and symptom management.

[2]  I. Higginson,et al.  Improving end-of-life care for patients with chronic heart failure: “Let’s hope it’ll get better, when I know in my heart of hearts it won’t” , 2007, Heart.

[3]  I. Higginson,et al.  A Multi-Professional Short-Term Group Intervention for Informal Caregivers of Patients Using a Home Palliative Care Service , 2002, Journal of palliative care.

[4]  A. Bharucha,et al.  Family Member Involvement in Hastened Death , 2007, Death studies.

[5]  Scott A Murray,et al.  Dying of lung cancer or cardiac failure: prospective qualitative interview study of patients and their carers in the community , 2002, BMJ : British Medical Journal.

[6]  H. Prigerson,et al.  Religiousness and Major Depression among Bereaved Family Caregivers: A 13–Month Follow-Up Study , 2006, Journal of palliative care.

[7]  P. Gagnon,et al.  Caring for a loved one with advanced cancer: determinants of psychological distress in family caregivers. , 2006, Journal of palliative medicine.

[8]  M. Groenvold,et al.  Expectations to and evaluation of a palliative home-care team as seen by patients and carers , 2006, Supportive Care in Cancer.

[9]  R. Malacrida,et al.  Reasons for dissatisfaction: a survey of relatives of intensive care patients who died. , 1998, Critical care medicine.

[10]  E. Csikai Bereaved hospice caregivers' perceptions of the end-of-life care communication process and the involvement of health care professionals. , 2006, Journal of palliative medicine.

[11]  C. Riley-Doucet Beliefs About the Controllability of Pain: Congruence Between Older Adults With Cancer and Their Family Caregivers , 2005, Journal of family nursing.

[12]  L. Scott Technological Caregiving: A Qualitative Perspective , 2001 .

[13]  C. Ingleton The views of patients and carers on one palliative care service , 1999 .

[14]  Mary Kazanowski,et al.  Family Caregivers' Medication Management of Symptoms in Patients With Cancer Near Death , 2005 .

[15]  C. Todd,et al.  Supporting lay carers in end of life care: current gaps and future priorities , 2009, Palliative medicine.

[16]  P. Mcgrath,et al.  Needs and experiences of non-English-speaking hospice patients and families in an English-speaking country , 2001, The American journal of hospice & palliative care.

[17]  L. Emanuel,et al.  Challenges faced by informal caregivers of hospice patients in Uganda. , 2008, Journal of palliative medicine.

[18]  C. Heidebrecht,et al.  Preferences for place of care and place of death among informal caregivers of the terminally ill , 2005, Palliative medicine.

[19]  H. Prigerson,et al.  Bereavement services for family caregivers: how often used, why, and why not. , 2007, Journal of palliative medicine.

[20]  J. Wuest,et al.  Negotiating With Helping Systems: An Example of Grounded Theory Evolving Through Emergent Fit , 2000, Qualitative health research.

[21]  K. Acquaviva,et al.  Transformative aspects of caregiving at life's end. , 2005, Journal of pain and symptom management.

[22]  Allison Worth,et al.  Living with advanced heart failure: a prospective, community based study of patients and their carers , 2004, European journal of heart failure.

[23]  B. Given,et al.  Forgotten voices: lessons from bereaved caregivers of persons with a brain tumour. , 2004, International journal of palliative nursing.

[24]  P. Mckeever,et al.  Relationships between Nurses and Family Caregivers: Partners in Care? , 2000, ANS. Advances in nursing science.

[25]  P. Rhodes,et al.  Informal care and terminal illness. , 1999, Health & social care in the community.

[26]  Peter Hudson,et al.  Positive aspects and challenges associated with caring for a dying relative at home. , 2004, International journal of palliative nursing.

[27]  I. Higginson,et al.  Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. , 2000, Journal of palliative medicine.

[28]  S. Inouye,et al.  Associations between caregiver-perceived delirium in patients with cancer and generalized anxiety in their caregivers. , 2007, Journal of palliative medicine.

[29]  Colleen M McBride,et al.  The self-efficacy of family caregivers for helping cancer patients manage pain at end-of-life , 2003, PAIN®.

[30]  R. Grol,et al.  Assessment of the need for palliative care as perceived by individual cancer patients and their families , 2000, Cancer.

[31]  J. Addington-hall,et al.  Perspectives on symptom control in patients receiving community palliative care , 2003, Palliative medicine.

[32]  A. Milberg,et al.  Next of kin’s experience of powerlessness and helplessness in palliative home care , 2004, Supportive Care in Cancer.

[33]  W. Haley,et al.  Family Caregiving in Hospice: Effects on Psychological and Health Functioning Among Spousal Caregivers of Hospice Patients with Lung Cancer or Dementia , 2000, The Hospice journal.

[34]  F. Tyrer,et al.  Bereaved carers' views of a hospice at home service. , 2005, International journal of palliative nursing.

[35]  N. Perrin,et al.  Out‐of‐Hospital Death: Advance Care Planning, Decedent Symptoms, and Caregiver Burden , 2004, Journal of the American Geriatrics Society.

[36]  C. Becker,et al.  Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. , 2006, Age and ageing.

[37]  S. Murray,et al.  Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers , 2003, BMJ : British Medical Journal.

[38]  J. Talbott Depression Among Surviving Caregivers: Does Length of Hospice Enrollment Matter? , 2006 .

[39]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[40]  David C. Currow,et al.  Specialized palliative care services are associated with improved short- and long-term caregiver outcomes , 2007, Supportive Care in Cancer.

[41]  D. Moser,et al.  Emotional well-being in spouses of patients with advanced heart failure. , 2004, Heart & lung : the journal of critical care.

[42]  O. Spruyt,et al.  Community-based palliative care for Bangladeshi patients in east London. Accounts of bereaved carers , 1999, Palliative medicine.

[43]  Joseph D. Matarazzo,et al.  Behavioral health: A handbook of health enhancement and disease prevention , 1986 .

[44]  A. Loke,et al.  The Difficulties Faced by Informal Caregivers of Patients With Terminal Cancer in Hong Kong and the Available Social Support , 2003, Cancer nursing.

[45]  Wendy Armstrong,et al.  Building on Values: The Future of Health Care in Canada , 2005 .

[46]  K. White,et al.  Evaluation of a night respite community palliative care service. , 2004, International journal of palliative nursing.

[47]  A. Chang,et al.  Stress associated with tasks for family caregivers of patients with cancer in Hong Kong. , 1999, Cancer Nursing.

[48]  Sonja McIlfatrick,et al.  Assessing palliative care needs: views of patients, informal carers and healthcare professionals. , 2007, Journal of advanced nursing.

[49]  M. Skaff,et al.  Caregiving and the stress process: an overview of concepts and their measures. , 1990, The Gerontologist.

[50]  P. Craft,et al.  Family caregiver knowledge of treatment intent in a longitudinal study of patients with advanced cancer , 2003, Supportive Care in Cancer.

[51]  C E Smith A model of caregiving effectiveness for technologically dependent adults residing at home , 1994, ANS. Advances in nursing science.

[52]  J. Singer,et al.  Religious Coping among Caregivers of Terminally Ill Cancer Patients , 2006, Journal of health psychology.

[53]  P. Koop,et al.  The Bereavement Experience Following Home-Based Family Caregiving for Persons with Advanced Cancer , 2003, Clinical nursing research.

[54]  S. Carmel,et al.  Home death--the caregivers' experiences. , 2005, Journal of pain and symptom management.

[55]  Steve Hoppes Meanings and purposes of caring for a family member: an autoethnography. , 2005, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[56]  David A. Fleming,et al.  Caregiving near the end of life: Unmet needs and potential solutions , 2003, Palliative & Supportive Care.

[57]  E. Grunfeld The Impact of Caregiving on Family Caregivers of Women With Advanced Breast Cancer , 2005 .

[58]  I. Higginson,et al.  The relationship between patient characteristics and carer psychological status in home palliative cancer care , 2003, Supportive Care in Cancer.

[59]  D. Stewart,et al.  A brief problem-solving intervention for family caregivers to individuals with advanced cancer. , 2004, Journal of psychosomatic research.

[60]  C. Sinding “Because you know there's an end to it”: Caring for a relative or friend with advanced breast cancer , 2003, Palliative and Supportive Care.

[61]  L. Kristjanson,et al.  Palliative care and support for people with neurodegenerative conditions and their carers. , 2006, International journal of palliative nursing.

[62]  S. Folkman,et al.  Informal caregivers and the intention to hasten AIDS-related death. , 1998, Archives of internal medicine.

[63]  K. Stajduhar,et al.  Palliative Care at Home: Reflections on HIV/AIDS Family Caregiving Experiences , 1998, Journal of palliative care.

[64]  Bijay Sanjeev End of Life. , 2001, Journal of palliative medicine.

[65]  K. Pargament,et al.  God and the search for meaning among hospice caregivers. , 1998, The Hospice journal.

[66]  N. Perrin,et al.  Men as caregivers at the end of life. , 2005, Journal of palliative medicine.

[67]  L. Braitman,et al.  Approaching the end of life: attitudes, preferences, and behaviors of African-American and white patients and their family caregivers. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[68]  Deborah J. Cook,et al.  Family satisfaction with care in the intensive care unit: Results of a multiple center study* , 2002, Critical care medicine.

[69]  S. Nolen-Hoeksema,et al.  Predictors of Family Members’ Satisfaction with Hospice , 2000, The Hospice journal.

[70]  S. Zisook,et al.  The Psychological and Physical Health of Hospice Caregivers , 2000, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[71]  M. Kearney Levels and applications of qualitative research evidence. , 2001, Research in nursing & health.

[72]  John Bowlby,et al.  Attachment and Loss: Sadness and Depression , 1982 .

[73]  S. Fosså,et al.  Global quality of life in primary caregivers of patients with cancer in palliative phase staying at home , 2006, Supportive Care in Cancer.

[74]  S. Payne,et al.  Assessing the family and caregivers , 2008 .

[75]  V. Tilden,et al.  Family reports of barriers to optimal care of the dying. , 2000, Nursing research.

[76]  K. Stajduhar Examining the Perspectives of Family Members Involved in the Delivery of Palliative Care at Home , 2003, Journal of palliative care.

[77]  K. Stajduhar,et al.  Factors Influencing Family Caregivers' Ability to Cope With Providing End-of-Life Cancer Care at Home , 2008, Cancer nursing.

[78]  R. Harding,et al.  Clinical notes for informal carers in palliative care: recommendations from a random patient file audit , 2005, Palliative medicine.

[79]  T. Nelms A Most Wonderful, Tragic Experience: The Phenomenon of Mothering in Caregiving an Adult Son with AIDS , 2002 .

[80]  H. Prigerson,et al.  Length of hospice enrollment and subsequent depression in family caregivers: 13-month follow-up study. , 2006, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[81]  B. Ferrell,et al.  Distress and Quality of Life Concerns of Family Caregivers of Patients Undergoing Palliative Surgery , 2008, Cancer nursing.

[82]  K. Stajduhar,et al.  Interviewing Family Caregivers: Implications of the Caregiving Context for the Research Interview , 2009, Qualitative health research.

[83]  M. Burman,et al.  A qualitative study of self-transcendence in caregivers of terminally ill patients , 1999, The American journal of hospice & palliative care.

[84]  J. Wolff,et al.  End-of-life care: findings from a national survey of informal caregivers. , 2007, Archives of internal medicine.

[85]  P. Sjödén,et al.  Quality of life of cancer patients and their spouses in palliative home care , 1998, Palliative medicine.

[86]  C N Bull,et al.  Access and issues of equity in remote/rural areas. , 2001, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[87]  Chris Salisbury,et al.  The level of need for palliative care: a systematic review of the literature , 2000, Palliative medicine.

[88]  I. Higginson,et al.  Evaluation of a short-term group intervention for informal carers of patients attending a home palliative care service. , 2004, Journal of pain and symptom management.

[89]  A. Houldin A qualitative study of caregivers' experiences with newly diagnosed advanced colorectal cancer. , 2007, Oncology nursing forum.

[90]  S. Aranda,et al.  Intervention development for enhanced lay palliative caregiver support - the use of focus groups. , 2002, European journal of cancer care.

[91]  D. Clark,et al.  Carer satisfaction with end-of-life care in Powys, Wales: a cross-sectional survey. , 2004, Health & social care in the community.

[92]  P. Carter Caregivers' descriptions of sleep changes and depressive symptoms. , 2002, Oncology nursing forum.

[93]  J. Robinson,et al.  Family Caregiver Perception of Hospice Support , 2006 .

[94]  Allison M. Williams,et al.  The information transfer and knowledge acquisition geographies of family caregivers: an analysis of Canada's Compassionate Care Benefit. , 2007, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[95]  M. Bédard,et al.  Correlates of health status for family caregivers in bereavement. , 2002, Journal of palliative medicine.

[96]  H. Prigerson,et al.  Communication between physicians and family caregivers about care at the end of life: when do discussions occur and what is said? , 2005, Journal of palliative medicine.

[97]  S. Donnelly,et al.  Experience of the moment of death at home , 2006 .

[98]  D. Battistutta,et al.  Predictors of bereavement outcome for family carers of cancer patients , 1999, Psycho-oncology.

[99]  J D Arras,et al.  Bringing the hospital home. Ethical and social implications of high-tech home care. , 1994, The Hastings Center report.

[100]  D. Waldrop Caregiving Systems at the End of Life: How Informal Caregivers and Formal Providers Collaborate , 2006 .

[101]  A. Street,et al.  Karmic quest: Thai family caregivers promoting a peaceful death for people with AIDS , 2007, Contemporary nurse.

[102]  B. Given,et al.  A Profile of Bereaved Caregivers following Provision of Terminal Care , 1999, Journal of palliative care.

[103]  N. King,et al.  Family carers' experiences of out-of-hours community palliative care: a qualitative study. , 2004, International journal of palliative nursing.

[104]  J. Addington-hall,et al.  Community care for stroke patients in the last year of life: results of a national retrospective survey of surviving family, friends and officials. , 1998, Health & social care in the community.

[105]  E. Yeung,et al.  Family Experience Caring for Terminally Ill Patients With Cancer in Hong Kong , 2003, Cancer nursing.

[106]  S. Folkman,et al.  Relationship of daily hassles, uplifts, and major life events to health status , 1982 .

[107]  S. Aranda,et al.  Caregiving in Advanced Cancer: Lay Decision Making , 2001, Journal of palliative care.

[108]  David Clark,et al.  Macmillan Carers Schemes in England: results of a multicentre evaluation , 2000, Palliative medicine.

[109]  Douglas G. Altman,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials , 2001, The Lancet.

[110]  J. Somerville Palliative care: the experience of informal carers within the Bangladeshi community. , 2001, International journal of palliative nursing.

[111]  D. McConnell,et al.  The relationship between available support, unmet needs and caregiver burden in patients with advanced cancer and their carers , 2005, Psycho-oncology.

[112]  Phyllis N Butow,et al.  The needs of terminally ill cancer patients versus those of caregivers for information regarding prognosis and end‐of‐life issues , 2005, Cancer.

[113]  Karen M. Quinn,et al.  Evaluation of a psycho-educational group programme for family caregivers in home-based palliative care , 2008, Palliative medicine.

[114]  M. Costantini,et al.  Dying of cancer in Italy: impact on family and caregiver. The Italian Survey of Dying of Cancer , 2007, Journal of Epidemiology and Community Health.

[115]  E. Yeung,et al.  Perception of empowerment by family caregivers of patients with a terminal illness in Hong Kong. , 2002, International journal of palliative nursing.

[116]  L. Kristjanson,et al.  Development of a pain management programme for family carers of advanced cancer patients. , 2004, International journal of palliative nursing.

[117]  M. Mikulincer,et al.  Hidden morbidity in cancer: spouse caregivers. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[118]  G. Grant,et al.  A study of family carers of people with a life-threatening illness 1: the carers' needs analysis. , 2001, International journal of palliative nursing.

[119]  C. Tishelman,et al.  Advanced home care for cancer patients at the end of life: a qualitative study of hopes and expectations of family caregivers. , 2002, Scandinavian journal of caring sciences.

[120]  S. Fosså,et al.  Anxiety, depression, and quality of life in caregivers of patients with cancer in late palliative phase. , 2005, Annals of oncology : official journal of the European Society for Medical Oncology.

[121]  P. Koop,et al.  Factors which Influence Coping: Home-based Family Caregiving of Persons with Advanced Cancer , 2003, Journal of palliative care.

[122]  B. Ferrell,et al.  Concerns of family caregivers of patients with cancer facing palliative surgery for advanced malignancies. , 2003, Oncology nursing forum.

[123]  I. Higginson,et al.  Working with ambivalence: informal caregivers of patients at the end of life , 2001, Supportive Care in Cancer.

[124]  J. Bader,et al.  The Association Among Primary Caregiver and Hospice Services for Mexican Americans and Anglos , 2008 .

[125]  A. Francke,et al.  Home care for terminally ill Turks and Moroccans and their families in the Netherlands: carers' experiences and factors influencing ease of access and use of services. , 2003, International journal of nursing studies.

[126]  D. Parker,et al.  Family Caregivers, Their Needs, and Home-based Palliative Cancer Services , 2001 .

[127]  D. Stewart,et al.  Lifestyle interference and emotional distress in family caregivers of advanced cancer patients , 2002, Cancer.

[128]  S. Denham Part 2: Family Health During and After Death of a Family Member , 1999 .

[129]  D. Bass,et al.  The transition from caregiving to bereavement: the relationship of care-related strain and adjustment to death. , 1990, The Gerontologist.

[130]  L. Kristjanson,et al.  The family's cancer journey: A literature review , 1994, Cancer nursing.

[131]  G. Grande,et al.  Death at home unlikely if informal carers prefer otherwise: implications for policy , 2008, Palliative medicine.

[132]  B. Given,et al.  Burden and depression among caregivers of patients with cancer at the end of life. , 2004, Oncology nursing forum.

[133]  I. Kalnins Caring for the terminally ill: experiences of Latvian family caregivers. , 2006, International nursing review.

[134]  Silvia Rossi Ferrario,et al.  Advanced cancer at home: caregiving and bereavement , 2004, Palliative medicine.

[135]  M. Bédard,et al.  Service preferences among family caregivers of the terminally ill. , 2005, Journal of palliative medicine.

[136]  David C Currow,et al.  Caregiving for the terminally ill: at what cost? , 2005, Palliative medicine.

[137]  C. Seale Changing patterns of death and dying. , 2000, Social science & medicine.

[138]  R. Grol,et al.  Problems Experienced by the Informal Caregivers of Cancer Patients and Their Needs for Support , 2006, Cancer nursing.

[139]  W. Haley,et al.  Predictors of depression and life satisfaction among spousal caregivers in hospice: application of a stress process model. , 2003, Journal of palliative medicine.

[140]  A. Chang,et al.  Managing caregiver tasks among family caregivers of cancer patients in Hong Kong. , 1999, Journal of advanced nursing.

[141]  H. Prigerson,et al.  Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[142]  S. Barclay,et al.  Valued aspects of primary palliative care: content analysis of bereaved carers' descriptions. , 2004, The British journal of general practice : the journal of the Royal College of General Practitioners.

[143]  M. Maclean,et al.  End of Life Care: The Experience of Seniors and Informal Caregivers , 2002, Canadian Journal on Aging / La Revue canadienne du vieillissement.

[144]  Doug Coyle,et al.  Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers , 2004, Canadian Medical Association Journal.

[145]  I. Higginson,et al.  Factors influencing death at home in terminally ill patients with cancer: systematic review , 2006, BMJ : British Medical Journal.

[146]  E. Grunfeld,et al.  Caregiving for women with advanced breast cancer , 2003, Psycho-oncology.

[147]  M. Maclean,et al.  Giving support and getting help: Informal caregivers' experiences with palliative care services , 2004, Palliative and Supportive Care.

[148]  D. Waldrop,et al.  Final transitions: family caregiving at the end of life. , 2005, Journal of palliative medicine.

[149]  D. Deeg,et al.  The end of life: informal care for dying older people and its relationship to place of death , 2004, Palliative medicine.

[150]  S. V. Brinson,et al.  Hospice Family Caregivers: An Experience in Coping , 2000, The Hospice journal.

[151]  T. R. Taylor,et al.  Issues in end-of-life care: patient, caregiver, and clinician perceptions. , 2003, Journal of palliative medicine.

[152]  H. Abu‐Saad,et al.  Vulnerability of family caregivers in terminal palliative care at home; balancing between burden and capacity. , 2003, Scandinavian journal of caring sciences.

[153]  P. McGrath,et al.  'It's very difficult to get respite out here at the moment': Australian findings on end-of-life care for Indigenous people. , 2006, Health & social care in the community.

[154]  A. Chang,et al.  Experience of palliative home care according to caregivers' and patients' ages in Hong Kong Chinese people. , 2000, Oncology nursing forum.

[155]  L. Schmidt,et al.  Telephone Support for Caregivers of Patients With Cancer , 2003, Cancer nursing.

[156]  P. Butow,et al.  When and how to initiate discussion about prognosis and end-of-life issues with terminally ill patients. , 2005, Journal of pain and symptom management.

[157]  J. Bell,et al.  Beliefs: the heart of healing in families and illness , 1996 .

[158]  P. Jacobsen,et al.  Family caregiver quality of life: differences between curative and palliative cancer treatment settings. , 1999, Journal of pain and symptom management.

[159]  I. Byock The nature of suffering and the nature of opportunity at the end of life. , 1996, Clinics in geriatric medicine.

[160]  I. Higginson,et al.  Fit to care? A comparison of informal caregivers of first-generation Black Caribbeans and White dependants with advanced progressive disease in the UK. , 2003, Health & social care in the community.

[161]  S. Aranda,et al.  Home Caregivers of the Person With Advanced Cancer: AN AUSTRALIAN PERSPECTIVE , 2001, Cancer nursing.

[162]  B. Chang,et al.  Sleep and Depression in Cancer Caregivers , 2000, Cancer nursing.

[163]  D. Currow,et al.  The experience of supporting a dying relative: reflections of caregivers , 2005 .

[164]  R. McCorkle,et al.  Enhancing caregiver outcomes in palliative care. , 2001, Cancer control : journal of the Moffitt Cancer Center.

[165]  D. Moher,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials , 2001, The Lancet.

[166]  S. Lambert,et al.  Concerns of hospice patient caregivers. , 2002, The ABNF journal : official journal of the Association of Black Nursing Faculty in Higher Education, Inc.

[167]  C. Becker,et al.  Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus , 2005, Journal of the American Geriatrics Society.

[168]  C. Cleeland,et al.  The Birmingham International Workshop on Supportive, Palliative, and End‐of‐Life Care Research , 2006, Cancer.

[169]  S. Bourgeois,et al.  Essence of caring for a person dying. , 2003, Nursing & health sciences.

[170]  P. Atkinson,et al.  Key themes in qualitative research: continuities and changes , 2002 .

[171]  Stephen Gillam,et al.  Needs assessment: from theory to practice , 1998, BMJ.

[172]  P. Yates,et al.  Family coping: issues and challenges for cancer nursing. , 1999, Cancer nursing.

[173]  S. Murray,et al.  Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers , 2004, Palliative medicine.

[174]  W. Haley,et al.  Impact of coping skills intervention with family caregivers of hospice patients with cancer , 2006, Cancer.

[175]  S. D'haese Palliative Care Nursing: A guide to Practice , 2004 .

[176]  A. Baum,et al.  End-of-life caregiving: what helps family caregivers cope? , 2003, Journal of palliative medicine.

[177]  E Eriksson,et al.  Caring for cancer patients: relatives' assessments of received care. , 2001, European journal of cancer care.

[178]  S. Barclay,et al.  Caregiver Bereavement Outcome: Relationship with Hospice at Home, Satisfaction with Care, and Home Death , 2004, Journal of palliative care.

[179]  E. Glaser The randomized clinical trial. , 1972, The New England journal of medicine.

[180]  P. Carter Family Caregivers’ Sleep Loss and Depression Over Time , 2003, Cancer nursing.

[181]  S. Zisook,et al.  Depression and grief reactions in hospice caregivers: from pre-death to 1 year afterwards. , 2002, Journal of affective disorders.

[182]  L. Jones,et al.  Reducing emotional distress in people caring for patients receiving specialist palliative care , 2007, British Journal of Psychiatry.

[183]  S. Barclay,et al.  The influence of patient and carer age in access to palliative care services. , 2006, Age and ageing.

[184]  Margarete Sandelowski,et al.  Classifying the Findings in Qualitative Studies , 2003, Qualitative health research.

[185]  S. Cadell Trauma and growth in Canadian carers , 2003, AIDS care.

[186]  C. Guarnaccia,et al.  Two models of caregiver strain and bereavement adjustment: a comparison of husband and daughter caregivers of breast cancer hospice patients. , 2003, The Gerontologist.

[187]  J. Gaugler,et al.  Useful services for families: research findings and directions , 1999, International journal of geriatric psychiatry.

[188]  Nijmeh Al-Atiyyat,et al.  Roy Adaptation Model , 2013 .

[189]  N. Cuellar,et al.  Depression in Rural Hospice Family Caregivers , 2003 .

[190]  D. Currow,et al.  Terminally-ill people living alone without a caregiver: an Australian national scoping study of palliative care needs , 2007, Palliative medicine.

[191]  Jared R Anderson,et al.  The last mile of the way: understanding caregiving in African American families at the end-of-life. , 2004, Journal of marital and family therapy.

[192]  M. Lieberman,et al.  The stress process. , 1981, Journal of health and social behavior.

[193]  A. Antonovsky,et al.  The life crisis history as a tool in epidemiological research. , 1967, Journal of health and social behavior.

[194]  G. Boulton‐Lewis,et al.  Experience of dying: concerns of dying patients and of carers , 2006, Internal medicine journal.

[195]  D. Parker,et al.  The Emotions and Coping Strategies of Caregivers of Family Members with a Terminal Cancer , 2001, Journal of palliative care.

[196]  L. Leach,et al.  Cognitive functioning under stress: evidence from informal caregivers of palliative patients. , 2007, Journal of palliative medicine.

[197]  L. Kristjanson,et al.  Challenging the framework for evidence in palliative care research , 2005, Palliative medicine.

[198]  Jane Hall,et al.  Home-based palliative care in Sydney, Australia: the carer's perspective on the provision of informal care. , 2006, Health & social care in the community.

[199]  Lyman W. Porter,et al.  A study of perceived need satisfactions in bottom and middle management jobs. , 1961 .

[200]  K. Cox,et al.  Evaluating the impact of a cancer supportive care project in the community: patient and professional configurations of need. , 2007, Health & social care in the community.

[201]  L. Siminoff,et al.  The role of the family in treatment decision making by patients with cancer. , 2003, Oncology nursing forum.

[202]  S. Fosså,et al.  Primary caregivers of cancer patients in the palliative phase: a path analysis of variables influencing their burden. , 2006, Social science & medicine.

[203]  A. Milberg,et al.  What to do when ‘there is nothing more to do’? A study within a salutogenic framework of family members' experience of palliative home care staff , 2007, Psycho-oncology.

[204]  W. Duggleby,et al.  The Experience of Hope for Informal Caregivers of Palliative Patients , 2005, Journal of palliative care.

[205]  Philip Smith,et al.  Identifying the concerns of informal carers in palliative care , 1999, Palliative medicine.

[206]  V. Braithwaite Contextual or general stress outcomes: making choices through caregiving appraisals. , 2000, The Gerontologist.

[207]  S. Aranda,et al.  A psycho-educational intervention for family caregivers of patients receiving palliative care: a randomized controlled trial. , 2005, Journal of pain and symptom management.

[208]  K. Luker,et al.  Users’ Views of Palliative Care Services: ethical implications , 2000, Nursing ethics.

[209]  L. D. de Witte,et al.  Transmural care of terminal cancer patients: effects on the quality of life of direct caregivers. , 1998, Nursing research.

[210]  P. Hudson How well do family caregivers cope after caring for a relative with advanced disease and how can health professionals enhance their support? , 2006, Journal of palliative medicine.

[211]  J. Morse,et al.  Toward an Experiential Theory of Bereavement , 1996 .

[212]  D. Fairclough,et al.  Understanding Economic and Other Burdens of Terminal Illness: The Experience of Patients and Their Caregivers , 2000, Annals of Internal Medicine.

[213]  S. Folkman,et al.  Stress, appraisal, and coping , 1974 .

[214]  P. Laippala,et al.  Patient satisfaction and research-related problems (Part 1). Problems while using a questionnaire and the possibility to solve them by using different methods of analysis. , 2000, Journal of nursing management.

[215]  J. Fuh,et al.  Which Level of Care Is Preferred for End-Stage Dementia? Survey of Taiwanese Caregivers , 2002, Journal of geriatric psychiatry and neurology.

[216]  D. Clark,et al.  Place of death: preferences among cancer patients and their carers. , 2004, Social science & medicine.

[217]  L. Kristjanson,et al.  Mapping the Journey: Family Carers’ Perceptions of Issues Related to End-Stage Care of Individuals with Muscular Dystrophy or Motor Neurone Disease , 2003, Journal of palliative care.

[218]  D. Moher,et al.  The EQUATOR Network and reporting guidelines: Helping to achieve high standards in reporting health research studies. , 2009, Maturitas.

[219]  D. Cook,et al.  Dying in the ICU: perspectives of family members. , 2003, Chest.

[220]  I. McIntyre,et al.  An evaluation of the domiciliary occupational therapy service in palliative cancer care in a community trust: a patient and carers perspective. , 2005, European journal of cancer care.

[221]  P. Carter A Brief Behavioral Sleep Intervention for Family Caregivers of Persons With Cancer , 2006, Cancer nursing.

[222]  David A. Fleming,et al.  Caregiving at the end of life: Perceptions of health care quality and quality of life among patients and caregivers. , 2006, Journal of pain and symptom management.

[223]  S. Chattoo,et al.  The moral economy of selfhood and caring: negotiating boundaries of personal care as embodied moral practice. , 2008, Sociology of health & illness.

[224]  T. Quill,et al.  Working with families in palliative care: one size does not fit all. , 2006, Journal of palliative medicine.

[225]  S. Payne,et al.  Terminally ill patients' and lay-carers' perceptions and experiences of community-based services. , 1999, Journal of advanced nursing.

[226]  R. Hughes,et al.  Towards a culturally acceptable end-of-life survey questionnaire: a Bengali translation of VOICES. , 2005, International journal of palliative nursing.

[227]  B. Davies.,et al.  Variations in and factors influencing family members' decisions for palliative home care , 2005, Palliative medicine.

[228]  M. Miyashita,et al.  Family caregiver's experiences in caring for a patient with terminal cancer at home in Japan , 2007, Palliative and Supportive Care.

[229]  C. Gridelli,et al.  Informal Caregiving Burden in Advanced Non-small Cell Lung Cancer: The HABIT study , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[230]  L. Vlahos,et al.  Caregivers of Advanced Cancer Patients: Feelings of Hopelessness and Depression , 2007, Cancer nursing.

[231]  A. Milberg,et al.  Exploring comprehensibility and manageability in palliative home care: An interview study of dying cancer patients' informal carers , 2004, Psycho-oncology.

[232]  L. Kristjanson,et al.  Palliative Care for Families: Remembering the Hidden Patients , 2004, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[233]  M. Bédard,et al.  Caregiving and its impact on families of the terminally ill , 2003, Aging & mental health.

[234]  Kevin Brazil,et al.  From theory to practice: improving the impact of health services research , 2005, BMC health services research.

[235]  P. Koop,et al.  The Experience of Respite during Home-Based Family Caregiving for Persons with Advanced Cancer , 2002, Journal of palliative care.

[236]  P. Brown,et al.  Quality of Life of Caregivers of Patients With Advanced-Stage Cancer , 2006, The American journal of hospice & palliative care.

[237]  J. Owen,et al.  End of Life Care and Reactions to Death in African-American and White Family Caregivers of Relatives with Alzheimer's Disease , 2001, Omega.

[238]  L. Braitman,et al.  Family care giving for patients at life's end: Report from the Cultural Variations Study (CVAS) , 2003, Palliative and Supportive Care.

[239]  K. Brazil,et al.  Caregiving at the end of life: Perspectives from spousal caregivers and care recipients , 2007, Palliative and Supportive Care.

[240]  A. Bandura Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[241]  D. Waldrop Caregiver grief in terminal illness and bereavement: a mixed-methods study. , 2007, Health & Social Work.

[242]  J. Meyers,et al.  The relationships between family primary caregiver characteristics and satisfaction with hospice care, quality of life, and burden. , 2001, Oncology nursing forum.

[243]  I. Wilson,et al.  Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. , 1995, JAMA.

[244]  J. Wuest,et al.  Daughters Caring for Dying Parents: A Process of Relinquishing , 2007, Qualitative health research.

[245]  Joshua Hauser,et al.  Supporting family caregivers at the end of life: "they don't know what they don't know". , 2004, JAMA.

[246]  E. Emanuel,et al.  Who's caring for whom? Differing perspectives between seriously ill patients and their family caregivers , 2006, The American journal of hospice & palliative care.

[247]  G. Udén,et al.  The Meaning of Support as Narrated by Family Carers Who Care for a Senior Relative at Home , 2006, Qualitative health research.

[248]  M. Triemstra,et al.  The role of social and psychologic resources in caregiving of cancer patients , 2001, Cancer.

[249]  M. Nolan,et al.  An exploration of family carers’ experience of respite services in one specialist palliative care unit , 2005, Palliative Medicine.

[250]  S. Karlsen,et al.  Do home deaths increase distress in bereavement? , 2000, Palliative medicine.

[251]  T. Peters,et al.  Social class and access to specialist palliative care services , 2005, Palliative medicine.

[252]  L. Dorfman,et al.  Family support for hospice caregivers , 2002, The American journal of hospice & palliative care.

[253]  C. Berterö,et al.  How next of kin experience palliative care of relatives at home. , 2003, European journal of cancer care.

[254]  S. Wilkinson,et al.  A qualitative evaluation of the impact of palliative care day services: the experiences of patients, informal carers, day unit managers and volunteer staff , 2005, Palliative medicine.

[255]  D. Halpin,et al.  Living with severe chronic obstructive pulmonary disease (COPD): perceptions of patients and their carers , 2004, Palliative medicine.

[256]  Harry Campbell,et al.  Variant Creutzfeldt-Jakob disease: costs borne by families. , 2002, Health & social care in the community.

[257]  G. Devins Illness intrusiveness and the psychosocial impact of lifestyle disruptions in chronic life-threatening disease. , 1994, Advances in renal replacement therapy.

[258]  L. Funk,et al.  Part 2: Home-based family caregiving at the end of life: a comprehensive review of published qualitative research (1998-2008) , 2010, Palliative medicine.

[259]  L. Scott,et al.  Caregiving and Care Receiving among a Technologically Dependent Heart Failure Population , 2000, ANS. Advances in nursing science.

[260]  S. Andrews,et al.  Caregiver burden and symptom distress in people with cancer receiving hospice care. , 2001, Oncology nursing forum.

[261]  S. Fosså,et al.  The caregiver reaction assessment: psychometrics, and temporal stability in primary caregivers of Norwegian cancer patients in late palliative phase , 2006, Psycho-oncology.

[262]  K. Acquaviva,et al.  Benefits of training family caregivers on experiences of closure during end-of-life care. , 2007, Journal of pain and symptom management.

[263]  M. Carlsson,et al.  A comparison of patients dying at home and patients dying at a hospice: Sociodemographic factors and caregivers' experiences , 2003, Palliative and Supportive Care.

[264]  P. Yates,et al.  Are Supportive Services Meeting the Needs of Australians with Neurodegenerative Conditions and Their Families? , 2006, Journal of palliative care.

[265]  M. Eccles,et al.  Lay carers' satisfaction with community palliative care: results of a postal survey , 1999, Palliative medicine.

[266]  M Smith,et al.  Predictors of Family Satisfaction with an Australian Palliative Home Care Service: A Test of Discrepancy Theory , 1999, Journal of palliative care.

[267]  K. Sullivan,et al.  Hospice at Home service: the carer’s perspective , 2007, Supportive Care in Cancer.

[268]  C. Guarnaccia,et al.  Husband and Adult-Daughter Caregivers' Bereavement , 2002 .

[269]  S. Murray,et al.  Out-of-hours palliative care: a qualitative study of cancer patients, carers and professionals. , 2006, The British journal of general practice : the journal of the Royal College of General Practitioners.

[270]  Richard Harding,et al.  Meeting the communication and information needs of chronic heart failure patients. , 2008, Journal of pain and symptom management.

[271]  S. Dumont,et al.  End-of-Life Care and the Grieving Process: Family Caregivers Who Have Experienced the Loss of a Terminal-Phase Cancer Patient , 2008, Qualitative health research.