Problem-Solving Dimensions among Caregivers of People with Cancer Receiving Outpatient Palliative Care.

Family caregivers of people with cancer encounter a wide range of problems including challenges managing patients' symptoms, difficulties navigating complex healthcare systems, and financial stressors associated with caregiving. Outpatient palliative care teams are ideally positioned to help caregivers respond to these challenges; however, little evidence is available to inform problem-solving support for caregivers in this setting. This article presents results from a secondary analysis of data obtained as part of a randomized clinical trial of a problem-solving intervention for family caregivers of people with cancer receiving outpatient palliative care. It describes the extent to which caregivers report adoption of positive and negative problem orientations and use of rational, impulsive, and avoidant problem-solving styles, and examines whether these problem-solving dimensions differ by age and gender. Results reveal statistically significant negative correlations between caregiver age and positive and negative problem orientations and use of a rational problem-solving style, and statistically significant gender differences with regard to negative problem orientation and use of an impulsive problem-solving style. Findings from this exploratory study highlight unique potential strengths and needs of caregivers, and set the stage for future research on problem-solving among cancer caregivers in the growing field of outpatient palliative care.

Hungarian Social Caregivers' Challenges in Providing Home Care to Older Adults with Cancer.

In Hungary, as in most other countries, faces an aging population. Chronic illnesses, including cancer, among older adults often require assistance from family and formal caregivers. This study's objective was to understand Hungarian social (formal) caregivers' challenges providing care in the home for older adults diagnosed with cancer. A focus group design explored the experiences of 28 Hungarian social caregivers and 6 social work supervisors who work for county agencies responsible for formal caregiving services to older adults. The data reveal that the older adults often developed dependence on these caregivers for physical (personal), health-related, and "emotional" care. Caregivers also related difficult interactions with health providers and observation of ethical problems (autonomy, truth-telling, and justice). The complex nature of providing social care for Hungarian older adults with serious illness calls for policies that set increased requirements of educational competence and training.

Influential factors of well-being among Hungarian female hospice workers examined through structural equation modelling.

According to national hospice data in Hungary, approximately 1,600 healthcare employees and volunteers work in hospice care (country population of 9.9 million). The aim of the study was to identify and examine influential relationships among several variables that may affect well-being among female hospice workers. Structural equation modeling analysis was conducted utilising survey responses of 179 female hospice workers, including 79 nurses. Path analysis revealed that work over-commitment (being employed in more than one job) contributed to decreased psychological well-being through increased perceived stress, sleep difficulties and vital exhaustion. A greater sense of coherence was associated with lower levels of subjective stress, depressive symptoms and vital exhaustion and negatively correlated with over-commitment. Overall, even though the physical and mental burden of the workers is increasing because of increased use of hospice, according to these results, most still engaged in hospice work. Deeper analysis of the sense of coherence may point to development of effective interventions that can help maintain well-being of hospice workers and reduce attrition.

Social Work Assessment and Outcomes Measurement in Hospice and Palliative Care.

While psychosocial assessment is required in hospice, no requirement exists for documentation of psychosocial outcomes. Social work research has identified the psychosocial and spiritual domains most often and appropriate for social workers to address, and standardized assessment tools have been developed by social workers based on this research. The aims of this study were to document the current use of standardized assessment measures for assessment and documenting outcomes and specifically the use of the Social Work Assessment Tool. A national sample of 203 hospice and palliative care social workers was recruited for this mixed methods study. Results indicated that most social workers used a form developed by a nonsocial worker in the agency for the initial assessment, and many palliative care social workers were not responsible for the assessment. Fewer conducted a follow-up assessment or documented outcomes. No common standardized measure was used. This study confirmed anecdotal evidence about lack of standardized social work assessment and outcomes measurement occurring in hospice and palliative care. As the Centers for Medicare and Medicaid Services is likely to select a standardized tool to measure psychosocial outcomes, social workers have an opportunity to contribute a quantitatively driven outcomes measure, developed by social workers, that will demonstrate effectiveness of social work intervention and lead to a better understanding of the social work role in hospice and palliative care.