The hardest thing we have ever done - Palliative Care Australia

Such educational material was recently developed by Oldham and Kristjanson (2004), for a
cancer pain management education at home to support family carers. The ‘user friendly’
education program consisted of a Daily Comfort Diary to help family carers assess and
monitor pain and record their pain management strategies. A short video was included to
help family carers when moving their care recipient in or out of bed, walking with someone
who is unsteady and what to do if someone falls. Participating families were most
appreciative of the opportunity to learn how to care for their ill relative, reporting that the
program has eased some of the burden experienced by carers when it comes to pain relief. It
is ironic that while home health aides or personal care attendants require training before
they begin their caring role, informal carers provide similar services without the benefit of
formal preparation, and therefore much of their learning occurs on a trial and error basis
(Hudson, 1998).
In a randomised controlled trial to assess the efficacy of a psycho-educational intervention
for primary caregivers of cancer patients dying at home, primary caregivers reported that the
most challenging aspects of their role related to inadequate health professional support
(Hudson et al, 2004). Approximately one quarter of caregivers were disturbed by poor
continuity, inadequate information, limited respite, lack of symptom management education
and health professional role related issues. This research further found that most caregivers,
if given the opportunity, were willing to talk about issues specific to their needs and
concerns, and they chose to be interviewed without the presence of their care recipient, thus
emphasising the importance of more structured approaches to family care.
A consistent theme in the family-needs literature is the importance of communication
between health professionals and families (Kristjanson, Hudson & Oldham, 2003). Family
members need to feel confident that the patient’s comfort needs and perceptions of
symptoms are attended to, requiring liberal amounts of information about both disease and
treatment, provided in doses that they can process and at a pace that is comfortable to
them. Carers also benefit from information about diagnosis, prognosis, treatment options
and expected course of recovery to help lessen their fears and increase their sense of
predictability.
Barriers to seeking support
Barriers confronting health care professionals, regarding provision of support, need to be
acknowledged in order to design and implement interventions that are relevant and more
effective. Carers are often reluctant to disclose their needs to health professionals for
reasons that include not wanting to put their needs for care before those of the patient; not
wanting to be judged inadequate as a carer, and believing that concerns and distress are
inevitable and cannot be improved (Ramirez et al, 1998).
Payne and Ehrlich (1998) investigated three types of barriers which lead to carer reluctance
in seeking help: information-based, service-based and value-based. Lack of information
about the availability of services, including respite services, is the most common reason for
non-use of needed services. Service-based barriers include lack of flexibility in service
delivery. Value-based barriers involve caregiver guilt and commonly held beliefs and
misconceptions: carers may be reluctant to relinquish the caring role to others and may
experience a level of guilt in leaving their care recipients to seek support for their own
needs.
In palliative care, Hudson et al (2004) identified three types of barriers that present
challenges to health professionals: communication process barriers, health system barriers
and family-related challenges. ‘Communication process barriers’ referred to the possible
impaired concentration of caregivers due to anxiety and sleep deprivation or other stresses;
THE HARDEST THING WE HAVE EVER DONE: The Social Impact of Caring for Terminally Ill People in Australia, 2004
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