title: The contributions of family care-givers at end of life: A national post-bereavement census survey of cancer carers' hours of care and expenditures.
abstract: Family members provide vital care at end of life, enabling patients to remain at home. Such informal care contributes significantly to the economy while supporting patients' preferences and government policy. However, the value of care-givers' contributions is often underestimated or overlooked in evaluations. Without information on the activities and expenditures involved in informal care-giving, it is impossible to provide an accurate assessment of carers' contribution to end-of-life care.
  
  
  
  The aim of this study was to investigate the contributions and expenditure of informal, family care-giving in end-of-life cancer care.
  
  
  
  A national census survey of English cancer carers was conducted. Survey packs were mailed to 5271 people who registered the death of a relative to cancer during 1-16 May 2015. Data were collected on decedents' health and situation, care support given, financial expenditure resulting from care, carer well-being and general background information.
  
  
  
  In all, 1504 completed surveys were returned (28.5%). Over 90% of respondents reported spending time on care-giving in the last 3 months of the decedent's life, contributing a median 69 h 30 min of care-giving each week. Those who reported details of expenditure (72.5%) spent a median £370 in the last 3 months of the decedent's life.
  
  
  
  Carers contribute a great deal of time and money for day-to-day support and care of patients. This study has yielded a unique, population-level data set of end-of-life care-giving and future analyses will provide estimates of the economic value of family care-givers' contributions.
authors.affiliation: 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Rowland
authors.affiliation: 2 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hanratty
authors.affiliation: 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Pilling
authors.affiliation: 3 Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
authors.forename: Bernard
authors.initials: B
authors.lastname: van den Berg
authors.affiliation: 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Gunn
authors.initials: G
authors.lastname: Grande
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics* / Q000706:statistics & numerical data; D004739:England; D005190:Family; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000451:nursing*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000191:economics* / Q000706:statistics & numerical data
keywords: Informal care-giving; cancer; care-givers; cost analysis; palliative care