title: Correlation between patient quality of life in palliative care and burden of their family caregivers: a prospective observational cohort study.
abstract: BACKGROUND
  Family caregivers play a key role in palliative care at home, and understanding the interdependencies in the constellation of patient, family caregivers and service providers is important. As few longitudinal studies have examined the influence of patient quality of life (QoL) in palliative care on burden of family caregivers, the aim of this study was to identify correlations between changing patient QoL and changing burden of family caregivers that need consideration in patient management.
  
  
  METHODS
  Palliative patients with cancer in primary care evaluated their QoL (Quality of Life Questionnaire Core 15 Palliative Care, QLQ-C15-PAL). They were assessed monthly for an interval of 6 months or until death of the patient. Family caregivers reported the burden they perceived while supporting the patient (Short form of the Burden Scale for Family Caregivers, BSFC). Longitudinal data were analysed for all patients with at least 3 available assessments, considering the most recent data for participants with more than 3 assessments. Changes in patient QoL were analysed using the Friedman test. In a stepwise regression analysis, influences of change in patient QoL on changing caregiver burden were investigated.
  
  
  RESULTS
  One hundred patients (63 men, 37 women; average age: 68 years) were enrolled in the study. The most common primary diagnoses were colon, lung or breast cancer. In 58 cases, assessments were available from both patients and caregivers. Patients reported overall quality of life increasing towards end of life, although reporting that physical functioning deteriorated. Symptoms of pain and fatigue bothered patients most. Caregiver burden was moderate and on average did not change over time. In a stepwise regression model, the difference in emotional functioning and the difference in dyspnoea showed an influence on the development of caregiver burden (explained variance of 19.3%).
  
  
  CONCLUSIONS
  Patients' dyspnoea, feelings of depression and anxiety impacted on the perceived burden of family caregivers, but are manageable symptoms. Our results corroborate the need of regular assessment of patients' needs taking into account caregiver burden. In this way, general practice teams can intervene early and may more likely meet patients' needs in the end of life care process.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN78021852, assigned on 04/04/2007.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, Geb. 37, 69115, Heidelberg, Germany. katja.krug@med.uni-heidelberg.de.
authors.forename: Katja
authors.initials: K
authors.lastname: Krug
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, Geb. 37, 69115, Heidelberg, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Miksch
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, Geb. 37, 69115, Heidelberg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Peters-Klimm
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, Geb. 37, 69115, Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Engeser
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, Geb. 37, 69115, Heidelberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data*; D015331:Cohort Studies; D017281:Cost of Illness; D005221:Fatigue; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000523:psychology / Q000592:standards; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications; D011795:Surveys and Questionnaires