title: Specialized palliative care services are associated with improved short- and long-term caregiver outcomes.
abstract: OBJECTIVE
  The goal of this study was to evaluate, at a population level, the association between specialized palliative care services (SPCS) and short- and long-term caregiver outcomes.
  
  
  METHODS
  The Health Omnibus Survey, a face-to-face survey conducted annually in South Australia since 1991, collects health-related data from a rigorously derived, representative sample of 4,400 households. This study included piloted questions in the 2001, 2002, and 2003 Health Omnibus Survey on the impact of SPCS. Sample size was 9,088 individuals. "Unmet needs," a short-term outcome relevant to the caregiving period during a life-limiting illness, were tallied. "Moving on," a long-term caregiver-defined outcome reflecting the caregiver's adaptation and return to a new equilibrium after the death, was assessed with and without SPCS.
  
  
  RESULTS
  Thirty-seven percent (3,341) indicated that someone close to them had died of a terminal illness in the preceding 5 years, of whom 949 (29%) reported that they provided care. SPCS were involved in caring for 60% of deceased patients. Day-to-day caregivers indicated fewer unmet needs when SPCS were involved (p = 0.0028). More caregivers were able to "move on" with their lives when SPCS were involved than when SPCS were not involved (86 vs 77%, p = 0.0016); this effect was greatest in the first 2 years after the loved one's death.
  
  
  CONCLUSIONS
  At a population level, SPCS were associated with meaningful improvements in short-term ("unmet needs") and long-term ("moving on") caregiver-defined outcomes.
authors.affiliation: Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia 5042, Australia. abern003@mc.duke.edu
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
authors.forename: Belinda S
authors.initials: BS
authors.lastname: Fazekas
authors.forename: Mary A
authors.initials: MA
authors.lastname: Luszcz
authors.forename: Jane L
authors.initials: JL
authors.lastname: Wheeler
authors.forename: Maragatha
authors.initials: M
authors.lastname: Kuchibhatla
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001601:Bereavement; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000458:organization & administration; D012944:Social Support; D013021:South Australia; D013997:Time Factors