Abstract
Caregivers have complex needs as they care for a loved one with cancer at the end of life. The objective of this pilot study was to determine the feasibility of conducting a brief telephone intervention, Tele-Care II, for caregivers of hospice patients. Guided by Hogan's Model of Bereavement, nurse interventionists implemented Tele-Care II via teleconference calls with caregivers. Although 14 caregivers were recruited for the study, only 5 were able to complete the intervention before the patient's death. Those completing the intervention experienced decreased depression, despair, and disorganization although the patient's condition became more serious. Late enrollment in hospice continues to be problematic for patients, family caregivers, and hospice staff because it allows little time for completion of interventions with family caregivers before the patient's death.
Care of the dying has moved from the hospital to the home setting because of many social, economic, and medical factors. 1-3 As a result, family caregivers are found to have increasingly complex physical and psychological burdens as they care for dying family members. 4-8 When the terminally ill patient worsens, hospice care provides palliative and comfort measures for the patient and offers supportive care for family members. 9,10 However, as the patient's condition deteriorates, family caregivers tend to resist offers of help for themselves, 7,8 minimize their needs, and thus become increasingly vulnerable to physical illness and psychological distress. 11-14 Therefore, even if help is available, caregivers' consuming concern for their patients coupled with increasing burdens, stress, and depression prevents them from accepting the help they desperately need. 5,12-21
For more effective communication with family members who are hard to reach, use of the telephone has been suggested. The most obvious advantage of this method is that telephone communication is a familiar and comfortable activity with widespread acceptance. 22,23 Additionally, telephone contact may improve communication about sensitive issues because the family caregiver may feel less embarrassment and inhibition talking on the telephone than having face-to-face contact. 23-26 The telephone resolves other barriers to care for caregivers who are unable to leave home, have poor reading skills, or are unable to absorb information given in clinical settings. 23 It also may offer a cost-effective way to extend a caregiver support system. 23 Additionally, although distressed individuals are willing to initiate telephone calls to ask for help, needy persons often receive more timely help if health professionals initiate the calls. 23,27-29
For certain individuals there also may be disadvantages. Some may be unable to use the telephone because they are hard of hearing. Others may dislike talking on the telephone, and still others may resent the impersonal nature of the telephone, including inability to see the individual to whom they are talking.
Whereas telephone interventions with family caregivers of hospice patients have not yet been reported, the use of the telephone with other vulnerable groups has been helpful. Patients with cancer, 26,29,30 caregivers of patients with Alzheimer's disease, 31 patients receiving radiation therapy, 24 bereaved family members, 22 patients with hemophilia, 32 and patients with acquired immunodeficiency syndrome (AIDS) 33 have been responsive to telephone interventions.
The purposes of this pilot study were to evaluate recruitment and intervention protocols for the Tele-Care II intervention, to test the feasibility of a pre-post test assessment package, and to measure the results of the intervention. The answers to the following specific questions were sought. "Will family caregivers participate in the Tele-Care II intervention? Will the intervention be helpful? Will caregivers use the Tele-Care II workbook?" Guided by Hogan's Model of Bereavement, nurse interventionists implemented 4 weekly 1-hour sessions of Tele-Care II via teleconference calls with caregivers of hospice patients.