1. Potera, Carol


At the end of life, a study finds, five factors are in play.


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Surveys show that most people say they would prefer to die at home. But some family caregivers cope better than others with the strains of end-of-life care, and little research has explored why. Kelli Stajduhar, a Canadian nurse researcher, followed 29 family members caring for an adult dying from cancer and identified five factors that influence them: their approach to life, the patient's experience of the illness, the patient's gratitude for the caregiver, the relationship between caregiver and patient, and the caregiver's sense of security.


Caregivers who are positive, organized, and confident, and who find humor in predicaments, cope well. A one-day-at-a-time attitude allows them to cherish each day with patients. Caregivers also fare better when patients' symptoms such as nausea and pain are under control, when patients are eating and communicative, and when their relationship with the patient before the illness was a good one. Also, caregivers find motivation in dying patients' expressions of appreciation and respect. They felt reassured by family, friends, and clinicians who were available to help them.

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But when a patient is frustrated by the illness, the caregiver suffers, too. And because many caregivers will do anything to keep a dying family member at home, they often sacrifice their own health. Stajduhar told AJN: "Nurses can support family caregivers by pointing out to the dying person the contribution that [the family caregiver is] making to keep the patient at home. Nurses have to focus on the caregiver, not just the dying person."


Carol Potera


Stajduhar KI, et al. Cancer Nurs 2008;31(1):77-85.