Caregiver Well-being Connected to Patient Care

Cancer patients report lower quality of care when their caregivers are ill or depressed, according to data from the Cancer Care Outcomes Research and Surveillance (CanCORS) consortium.

“Many clinicians understand the importance of their patients’ caregivers and care about them,” Dr. Kristin Litzelman from University of Wisconsin in Madison told Reuters Health by email. “And yet caregivers often still get lost in the shuffle as ‘invisible patients,’ because of an array of barriers across many levels of the medical care system.”

Caregivers are key members of the patient’s care team, and recent research and theory have shown that caregiver and patient well-being are intertwined, but this has not been studied formally.

Dr. Litzelman’s team used data collected by the CanCORS Consortium between 2003 and 2006 to examine the association of family caregiver depressive symptoms and self-rated health with the perception of medical care quality by 672 patients with cancer.

Higher caregiver depression ratings were associated with an increased likelihood that patients would report poor quality of care, with each 1-point increase in caregiver depressive symptoms increasing that likelihood by 6%.

This association held only among caregivers with clinically significant levels of depressive symptoms, according to the August 29th Journal of Clinical Oncology online report.

When caregivers reported fair/poor self-rated health versus excellent/very good health, patients were 3.76 times more likely to report poor quality of care. This association, too, was significant only among caregivers with clinically significant levels of depressive symptoms.

“This suggests to me that reducing depressive symptoms – even a little, even if it’s not enough to bring the caregivers back under that ‘clinically significant’ threshold – might have an impact,” Dr. Litzelman said.

“When caregivers are depressed or ill, they are often instructed to go see their primary care physician,” she explained. “The caregiver may or may not follow up, given their time constraints and their focus on the patient. What this research suggests is that if those caregivers don’t go seek treatment for their depressive symptoms or health problems (or aren’t getting adequate, effective treatment), that comes back to the cancer patient’s medical team in a very real way.”

“It suggests that hospitals, clinics, and insurance providers have a very real incentive to find ways to help their patient’s caregivers – whether that is through a more family-centered brand of care, through psychosocial clinics that can serve caregivers as well as patients, or through other innovative approaches,” Dr. Litzelman said.

“The findings provide a springboard for conversations about how to pull caregivers out of the shadows,” Dr. Litzelman concluded. “I hope that the message physicians take away from this research is that taking care of the caregiver might have a trifecta of benefits – it can help the caregiver, help the patient, and potentially help the physician’s and practice’s outcomes. Efforts to innovate, to push toward a family-centered approach to care, may therefore be worthwhile. This study provides some evidence to help fuel those conversations.”

Reuters Health reported on August 29 that most adults in the U.S. who screen positive for depression are not being treated for it. In the Medical Expenditure Panel Surveys (MEPS), published in JAMA Internal Medicine, about 1 in 12 adults (8.4%) screened positive for depression, but only 28.7% of those who screened positive received any depression treatment during the survey year.

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Originally published August 2016

By Will Boggs MD, NEW YORK (Reuters Health)

(c) Copyright Thomson Reuters 2016

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