title: Transmural care of terminal cancer patients: effects on the quality of life of direct caregivers.
abstract: BACKGROUND
  The burden of caring for terminal cancer patients has a negative effect on the informal caregivers' quality of life.
  
  
  OBJECTIVE
  To investigate the effects of a transmural home care intervention program for terminal cancer patients on the direct caregivers' (the patient's principal informal caregiver) quality of life, compared with standard care programs. The intervention program intended to optimize the cooperation and coordination between the intramural and extramural health care organizations (transmural care).
  
  
  METHODS
  Direct caregivers of terminal cancer patients (estimated prognosis of less than 6 months) could be included in this quasi-experimental study. The direct caregivers' quality of life was measured in a multidimensional way 1 week before (T1), 1 week after (T2), and 4 weeks after (T3) the patient's discharge from the hospital (discharge being the starting point of the intervention), then again at 3 months after the patient's death (T4). Factor analyses on the four outcome measures yielded one factor. This was considered the primary outcome measure and was named the Overall Quality of Life Index (OQOLI).
  
  
  RESULTS
  Multiple regression analyses showed that the intervention contributed significantly positively to the direct caregivers' OQOLI at T2 (beta=.30; p < .05) and T4 (beta=.28; p < or = .05), compared with standard care.
  
  
  CONCLUSIONS
  Transmural care forms a significantly positive contribution to the OQOLI of direct caregivers of terminal cancer patients 1 week after the patient's discharge from the hospital and 3 months after the patient's death. Good terminal care also appears to be important for direct caregivers as well, with respect to perceived quality of life.
authors.affiliation: Department of Multidisciplinary Oncology, Catharina Hospital Eindhoven, The Netherlands. fsk@iaehv.nl
authors.forename: F W
authors.initials: FW
authors.lastname: Smeenk
authors.forename: L P
authors.initials: LP
authors.lastname: de Witte
authors.forename: J C
authors.initials: JC
authors.lastname: van Haastregt
authors.forename: R M
authors.initials: RM
authors.lastname: Schipper
authors.forename: H P
authors.initials: HP
authors.lastname: Biezemans
authors.forename: H F
authors.initials: HF
authors.lastname: Crebolder
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003152:Community Health Nursing / Q000458:organization & administration*; D017281:Cost of Illness; D005163:Factor Analysis, Statistical; D005190:Family / Q000523:psychology*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D015397:Program Evaluation; D011788:Quality of Life; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration*