title: Caregiver unmet needs, burden, and satisfaction in symptomatic advanced cancer patients at a Veterans Affairs (VA) medical center.
abstract: OBJECTIVE
  Caregiver outcomes among those caring for symptomatic advanced cancer patients at VA Medical Centers have not been well reported. The purposes of this study were (1) to identify the caregiver characteristics and their unmet needs; (2) to examine the association between caregiver unmet needs, caregiver burden, and caregiver satisfaction; and (3) to identify the independent predictors of different caregiver outcomes.
  
  
  METHODS
  One hundred caregivers completed three caregiver outcomes instruments: Family Inventory of Needs (FIN), Care Strain Index (CSI), and Family Satisfaction with Advanced Cancer Care (FAMCARE). The caregivers' demographics and their function, depression, health status, and social support status as well as the caregivers' perception of the patients' unmet needs (PPUN) were obtained. Principal component analysis was performed to examine the underlying dimensions of caregiver outcome measures. Pearson correlation and stepwise multivariate regression analyses were performed.
  
  
  RESULTS
  The median number of unmet needs was 2 and the median CSI score was 4. Most of unmet needs were related to information needs (needing more information related to home care, finding help with the problems at home, and disease prognosis) and symptom management. The majority of caregivers were satisfied or very satisfied by the care patients received. Spouse caregivers (N = 60, 60%) were significantly older (p = 0.006) with higher unemployment rates (p = 0.001), higher depression scores (p = 0.04), and lower social support scores (p < 0.0001) than nonspouse caregivers (N = 40, 40%). The PPUN predicted caregiver burden and the presence of caregiver unmet needs independently. The presence of caregiver unmet needs was the only independent predictor of caregiver satisfaction. Caregivers with a high PPUN and higher depression score experienced a higher burden.
  
  
  CONCLUSIONS
  The caregiver outcome model is proposed and needs to be further validated in a new cohort of caregivers.
authors.affiliation: Section Hematology/Oncology (111), VA New Jersey Health Care System, East Orange 07018, USA. shirley.hwang@med.va.gov
authors.forename: Shirley S
authors.initials: SS
authors.lastname: Hwang
authors.forename: Victor T
authors.initials: VT
authors.lastname: Chang
authors.forename: Yvette
authors.initials: Y
authors.lastname: Alejandro
authors.forename: Pamela
authors.initials: P
authors.lastname: Osenenko
authors.forename: Casaundra
authors.initials: C
authors.lastname: Davis
authors.forename: Janet
authors.initials: J
authors.lastname: Cogswell
authors.forename: Shanthi
authors.initials: S
authors.lastname: Srinivas
authors.forename: Basil
authors.initials: B
authors.lastname: Kasimis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D003258:Consumer Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D020380:Needs Assessment; D009369:Neoplasms; D009515:New Jersey; D010166:Palliative Care; D012044:Regression Analysis; D015203:Reproducibility of Results; D014728:Veterans