title: Advanced cancer at home: caregiving and bereavement.
abstract: BACKGROUND
  The advanced and terminal phases of cancer are being increasingly treated at home with the aid of palliative care teams. It is well known that caregivers are overburdened emotionally, financially and physically, and some studies have demonstrated that this overload extends beyond the period of mourning. Identifying caregivers at risk of bereavement maladjustment is a useful means of ensuring prompt psychological and social assistance, and optimising the available resources.
  
  
  METHODS
  One hundred and eleven caregivers of home-treated patients with advanced/terminal cancer were recruited by the palliative care unit operating in their place of residence. After giving their informed consent, all of the caregivers were asked to complete questionnaires designed to evaluate various emotional, financial and social aspects. Three, six and 12 months after the decease of their patients, the caregivers were contacted again and asked to complete other questionnaires aimed at assessing their emotional reactions and bereavement-related problems.
  
  
  RESULTS
  The 12-month follow-up was completed by 93 caregivers. Their bereavement maladjustment problems correlated with their perception of emotional distress and the caregiving-related problems detected at the time of referral, particularly among females. Spouses, subjects aged over 61 years and those perceiving a substantial emotional burden proved to be at greater long-term risk.
  
  
  CONCLUSIONS
  The identification of overburdened caregivers and those at risk of long-term bereavement maladjustment may facilitate the programming of ad hoc interventions that could reduce inherent health and social costs. Palliative care teams can usefully include someone to identify such caregivers by means of inexpensive and objectively predictive instruments.
authors.affiliation: Psychology Unit, S Maugeri Foundation, IRCCS, Scientific Institute of Veruno (NO), Italy. sferrario@fsm.it
authors.forename: Silvia
authors.initials: S
authors.lastname: Rossi Ferrario
authors.forename: Venerando
authors.initials: V
authors.lastname: Cardillo
authors.forename: Franco
authors.initials: F
authors.lastname: Vicario
authors.forename: Elena
authors.initials: E
authors.lastname: Balzarini
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Zotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D005192:Family Health; D005195:Family Relations; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology