Tumor Clinical Trial
Official title:
The Needs and Burden of Family Caregivers of Older Adults With Cancer and Their Social Determinants
Elderly cancer patients need more help from their relatives and for longer than young adults.
Our hypothesis of research is that the needs and resources to help the couple " elderly
patient/caregiver ", are at least in part socially determined and that the implementation of
a personalized support plan to help the caregiver (PSP) taking into account needs, resources
and expectations of the primary caregiver in addition to those of elderly patients with
cancer may partly correct inequalities. The PSP should allow a better management of cancer, a
lesser burden for the caregiver and a better quality of life for both the caregiver and the
patient.
Scientific context Elderly cancer patients need more help from their relatives and for longer
than young adults. The person who takes primary responsibility for someone who cannot care
fully for themselves is called the primary caregiver.
A recent personal study concerning elderly cancer patients caregivers show that most
caregivers reported high or moderate levels of psychological distress, with an impact on
their own health status.
In addition, family caregivers often report deficits in information about the disease, in
training and skills related to their patients' care, and a lack of assistance from healthcare
professionals.
The ability of the primary caregiver to meet the medical, material and emotional needs of the
patient depends on their own resources (psychological, physical, intellectual, physical,
financial) and on the diversity of their social network, but it also depends on the quality
of the personalized support program (including information and training) that has been
established for them.
Research hypotheses
Our hypothesis of research is that the needs and resources to help the couple " elderly
patient/caregiver ", are at least in part socially determined and that the implementation of
a personalized support plan to help the caregiver (PSP) taking into account needs, resources
and expectations of the primary caregiver in addition to those of elderly patients with
cancer may partly correct inequalities. The PSP should allow a better management of cancer, a
lesser burden for the caregiver and a better quality of life for both the caregiver and the
patient.
Intervention description
Prospective, interventional, randomized trial, with 118 patients in each group:
- an experimental interventional arm including an interview of the primary caregivers to
identify their needs and expectations, the implementation of a "personalized support
program", including telephone follow-up
- A control arm corresponding to the standard care. Caregiver aid is usually proposed when
accompanying a sick relative in consultation or hospitalization.
All the "couples patient / caregiver' will benefit initially from:
1. a comprehensive geriatric assessment (elderly patients with cancer)
2. an assessment of caregiver burden by the Zarit burden interview (ZBI)
3. an assessment of subjective well-being
4. an individual assessment of the precariousness and health inequalities based on the
score EPICES (Evaluation of precariousness and health inequalities in the health
Centers)
Randomization will be stratified according to:
- living in the same household or not
- score of initial Zarit Burden Interview
Intervention Stage 1: A semi-structured interview centered on the caregiver's needs (COAT
tool) Stage 2: guided questionnaires to assess the psychosocial situation of caregivers Stage
3: implementation of a multi-component PSP (information, counseling, listening time, training
to help overcome their difficulties as a caregiver, planning for future care) Stage 4: at
least one monthly phone interview Stage 5: 6 months follow up on the psychosocial
characteristics of caregivers
Expected results in public health Our study will help to better define the way to take better
account of the needs of the helper / helped couple, and reinforce the role of the
coordinating nurse in the care pathways.
If our hypotheses can confirmed that there is a link between the caregivers needs and the
social determinants of health and that the intervention has a positive impact on the
caregivers burden and stress, it will suggest that this intervention not only acts favorably
on social inequalities in health, but it can help reduce health care costs, as the caregiver
exhaustion increases the risk of health expenditure (drug consumption, hospitalization of the
patient and of the caregiver).
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