Clinical Practice Guidelines for the management of locally advanced ...

Informal or family caregivers derived significant benefit from the involvement of palliative care
services in terms of their satisfaction with the care delivered, improvement in communication and
their own improved quality of life.
Caregivers expressed increased satisfaction with quality of care. 8, 11, 13, 18-23 Hughes 8 reported an
increase in satisfaction in relation to access to care and the technical quality, interpersonal elements
and outcomes of care. Kane 11, 22 also found that carers reported better interaction with professionals
and greater satisfaction with their own involvement in care. Ringdal 20 and Jordhøy 18 identified
caregiver satisfaction with the availability of doctors to the family. This study also identified
significantly improved satisfaction with a number of aspects of the information carers were given
about the patient’s prognosis and progress. Increased satisfaction with communication was also
identified by Hughes 8 and SUPPORT. 32
Where 24-hour practical nursing care in the home (hospital in the home) was compared with usual
home care by a GP and district nurse 15 , significantly more unmet need for night nursing support and
for support for the carer in looking after the patient was identified in the control group. A study on the
impact of an intervention in caregivers’ coping skills showed a reduction in both task burden and the
burden of the patients’ symptoms for carers. 10
However in one study 13 , caregiver morale was lower in carers whose relative survived more than 30
days after discharge from hospital. This may reflect the continuing burden of caring when the
expectation was for a short terminal illness.
A significant finding was an improvement in carers’ overall quality of life 8, 10 , with Hughes 8 finding
improvement in several specific domains relating to quality of life, including physical function,
physical and emotional aspects of role function, mental health and social function. Addington-Hall 17
and Raftery 31 identified a decrease in caregiver expression of anger at the thought of the patient’s
death.
Provision of end-of-life care is a significant burden for informal caregivers. The evidence suggests
this burden can be reduced through adequate provision of palliative care services, leading to improved
outcomes for the family. This has the potential to have a major impact given the size of the
population.
Palliative Care Question 3. In men with metastatic prostate cancer what is the evidence that
specialist palliative care can assist patients and families in providing effective end of life care?
Evidence summary Level References
In men with metastatic prostate cancer there is evidence that
coordinated interdisciplinary palliative care can assist patients and
families in providing effective end-of-life care, with more time spent
out of hospital and reduction in the burden of providing care.
Recommendation:
II 8-13, 15-23,
31, 32
Men with metastatic prostate cancer and their families should be referred for a coordinated
palliative approach to assist in providing effective end of life care.
Grade C
101
Palliative care