title: Association between the emotional status of family caregivers and length of stay in a palliative care unit: A retrospective study.
abstract: OBJECTIVE
  Several factors associated with referral time to hospice and/or palliative care services have been identified, but there is no literature on the association between these services and the emotional status of the family caregivers (FCs). This article is intended to address that issue.
  
  
  METHODS
  A semistructured interview was employed to collect data for a retrospective cohort study. The primary FCs of terminally ill cancer patients were interviewed at the time of the patient's referral to the palliative care unit. Interview data were combined with patients' medical record data for our analysis. The emotional status of the FCs was categorized into one of three groups according to their responses to the anticipated death of their family member: acceptance, anxious/depressed, and denial/angry. A Cox proportional hazard model was used to examine and identify the factors related to the length of stay (LOS) in the palliative care unit.
  
  
  RESULTS
  A total of 198 patient-FC pairs were identified. The median LOS was 18 days. A multivariate analysis with adjustment for potential variables revealed significant differences in LOS according to cancer type and time since cancer diagnosis. The denial/angry FC category was independently associated with a shorter LOS (vs. acceptance, adjusted hazard ratio (aHR) 2.11; 95% confidence interval (CI), 1.11-4.03).
  
  
  CONCLUSIONS
  We found that terminally ill cancer patients who were referred late had FCs who were in denial or were angry about the anticipated death of their loved one. The emotional status of FCs should be considered when patients with terminal cancer are referred to palliative care.
authors.affiliation: Department of Family Medicine,Gachon University Gil Medical Center,Incheon,Korea.
authors.forename: Seon Hee
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Family Medicine,Gachon University Gil Medical Center,Incheon,Korea.
authors.forename: In Cheol
authors.initials: IC
authors.lastname: Hwang
authors.affiliation: Department of Family Medicine,Gachon University Gil Medical Center,Incheon,Korea.
authors.forename: Ki Dong
authors.initials: KD
authors.lastname: Ko
authors.affiliation: Palliative Care Unit,Incheon Regional Cancer Center,Incheon,Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Kwon
authors.affiliation: Department of Statistics,Dongguk University,Seoul,Korea.
authors.forename: Hong Yup
authors.initials: HY
authors.lastname: Ahn
authors.affiliation: Department of Family Medicine,Gachon University Gil Medical Center,Incheon,Korea.
authors.forename: Nan Young
authors.initials: NY
authors.lastname: Cho
authors.affiliation: Department of Family Medicine,Gachon University Gil Medical Center,Incheon,Korea.
authors.forename: Seung Jin
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D015331:Cohort Studies; D003643:Death; D004644:Emotions; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology; D010166:Palliative Care / Q000523:psychology*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Emotions; Family caregiver; Length of stay; Palliative care