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Reducing emotional distress in people caring for patients receiving specialist palliative care

Randomised trial

Department of Mental Health Sciences, Royal Free and University College Medical School, London

ADRIAN TOOKMAN, FRCP

Edenhall Marie Curie Centre, London

CHRISTINA MASON, PhD

St Joseph’s Hospice, Hackney, London

JOANNE McLOUGHLIN, MSc, ROBERT BLIZARD, MSc and MICHAEL KING, PhD

Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK

Correspondence: Professor Michael King, Department of Mental Health Sciences, University College London, London NW3 2PF, UK. Tel: +(0)20 7830 2397; fax +(0)2 7830 2808; email: m.king{at}medsch.ucl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Caring for relatives with advanced cancer may cause psychological and physical ill health.

Aims To evaluate the effectiveness of increased support for distressed, informal carers of patients receiving palliative care.

Method The sample was composed of 271 informal carers who scored over 5 on the 28-item General Health Questionnaire (GHQ–28). The intervention comprised six weekly visits by a trained advisor. Primary outcome was carer distress (GHQ–28) at 4-week, 9-week and 12-week follow-up. Secondary outcomes were carer strain and quality of life, satisfaction with care, and bereavement outcome.

Results Scores on the GHQ–28 fell below the threshold of 5/6 in a third of participants in each trial arm at any follow-up point. Mean scores in the intervention group were lower at all time points but these differences were not significant. No difference was observed in secondary outcomes. Carers receiving the intervention reported qualitative benefit.

Conclusions The intervention might have been too brief, and ongoing help might have had accruing benefits. Alternatively, informal carers of patients with cancer may already receive considerable input and the advisor’s help gave little additional advantage; or caring for a dying relative is extremely stressful and no amount of support is going to make it much better.

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