title: Understanding the barriers to identifying carers of people with advanced illness in primary care: triangulating three data sources.
abstract: BACKGROUND
  Approximately 10% of the UK population have an unpaid caring role for a family member or friend. Many of these carers make a significant contribution to supporting patients at the end of life. Carers can experience poor physical and psychosocial wellbeing, yet they remain largely unsupported by health and social care services. Despite initiatives for general practices to identify carers and their needs, many remain unidentified. Neither are carers self-identifying and requesting support. This study set out to explore the barriers to, and consider strategies for, identifying carers in primary care.
  
  
  METHODS
  We integrated findings from three data sources - a review of the caregiving literature; a workshop with researchers who have undertaken research with those caring at the end of life, and focus groups with carers and health professionals.
  
  
  RESULTS
  Three categories of barrier emerged. 1) Taking on the care of another person is often a gradual process, carers did not immediately identify with being a 'carer' - preferring to think of themselves in relational terms to the patient e.g. spouse, sibling, son or daughter. Often it was health and social care professionals who encouraged carers to consider themselves as an unpaid carer. 2) As the cared-for person's condition deteriorated, the caring role often became all-encompassing so that carers were managing competing demands, and felt unable to look after their own needs as well as those of the cared-for person. 3) There was ambiguity about the legitimacy of carer needs and about the role of the primary health care team in supporting carers, from both the perspective of the carers and the health professionals. GPs were thought to be reactive rather than proactive which discouraged carers from asking for help.
  
  
  CONCLUSIONS
  The needs of carers have to be legitimised to ensure primary care staff are proactive in their approach and carers are empowered to utilise the support available. Strategies to identify carers have to be sensitive to the complex dynamics of a caring relationship as well as the primary care context. Identification is a key factor in improving support for carers themselves and to enable them to support the patient.
authors.affiliation: Primary Palliative Care Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK. Emma.Carduff@ed.ac.uk.
authors.forename: Emma
authors.initials: E
authors.lastname: Carduff
authors.forename: Anne
authors.initials: A
authors.lastname: Finucane
authors.forename: Marilyn
authors.initials: M
authors.lastname: Kendall
authors.forename: Alison
authors.initials: A
authors.lastname: Jarvis
authors.forename: Nadine
authors.initials: N
authors.lastname: Harrison
authors.forename: Jane
authors.initials: J
authors.lastname: Greenacre
authors.forename: Scott A
authors.initials: SA
authors.lastname: Murray
mesh_terms: D017028:Caregivers / Q000600:supply & distribution*; D003625:Data Collection; D006301:Health Services Needs and Demand; D006801:Humans; D011320:Primary Health Care