title: Caring at home until death: enabled determination.
abstract: The importance of family caregivers in providing palliative care at home and in supporting a home death is well supported. Gaining a better understanding of what enables palliative family caregivers to continue caring at home for their family members until death is critical to providing direction for more effective support. The purpose of the study was to describe the experiences of bereaved family caregivers whose terminally ill family members with advanced cancer were successful in achieving a desired home death.
  
  
  
  A qualitative interpretive descriptive approach was used. Data were collected using semi-structured, audio-recorded interviews conducted in-person or via telephone in addition to field notes and reflective journaling. The study took place in British Columbia, Canada, and included 29 bereaved adult family caregivers who had provided care for a family member with advanced cancer and experienced a home death.
  
  
  
  Four themes captured the experience of caring at home until death: context of providing care, supportive antecedents to providing care, determination to provide care at home, and enabled determination. Factors that enabled determination to achieve a home death included initiation of formal palliative care, asking for and receiving help, augmented care, relief or respite, and making the healthcare system work for the ill person.
  
  
  
  Clarifying caregiving goals and supporting the factors that enable caregiver determination appear to be critical in enhancing the likelihood of a desired home death.
authors.affiliation: School of Nursing, University of British Columbia, ART 132, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada. Carole.robinson@ubc.ca.
authors.forename: Carole A
authors.initials: CA
authors.lastname: Robinson
authors.affiliation: School of Nursing, University of British Columbia, ART 223A, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Bottorff
authors.affiliation: School of Nursing, University of British Columbia, Kelowna, BC, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: McFee
authors.affiliation: College of Graduate Studies, University of British Columbia, EME 2121, 1137 Alumni Avenue, Kelowna, BC, V1V 1V7, Canada.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Bissell
authors.affiliation: British Columbia Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, BC, V1Y 5L3, Canada.
authors.forename: Gillian
authors.initials: G
authors.lastname: Fyles
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology*; D003643:Death; D005190:Family; D005260:Female; D006699:Home Care Services; D006801:Humans; D009369:Neoplasms / Q000451:nursing*; D010166:Palliative Care / Q000379:methods*; D019452:Terminally Ill / Q000523:psychology*
keywords: Family caregivers; Home death; Lay carers