Methods: Participants in this study were recruited through the Ottawa Community Care Access Centre. A total of 66 advanced cancer patients and their primary family caregivers were interviewed. The patient and caregiver interviews included a series of scales that assessed the following areas: patient and family caregiver characteristics, physical and psychological cancer symptoms, self-perceived burden, family caregiver emotional state, family caregiver role, and perspective taking. Each set of responses was then compared to assess the level of agreement between the advanced cancer patient and their family caregiver.

Findings: In general, family caregivers tend to overestimate the frequency, severity and distress of advanced cancer patients' symptoms. The tendency to overestimate was more common for psychological symptoms as opposed to physical symptoms. Family caregivers were slightly more accurate at assessing the severity of symptoms as compared to the frequency and distress. There was also a tendency for family caregivers to be more accurate at assessing concrete symptoms compared to subjective symptoms. Male caregivers tended to be less accurate than female caregivers at assessing physical symptoms and general distress. Also, the higher the level of caregiver burden, the less accurate caregivers were at assessing all types of symptoms.

Conclusions: Family caregivers play a significant role in the management of palliative patients in the home setting, and can strongly influence health care decisions for those patients who have difficulties communicating. The results of this small study indicate that family caregivers, especially men, have room to improve in terms of their accuracy at conducting assessments of advanced cancer patients, particularly in the area of assessing subjective, psychological symptoms. Interventions that focus on helping the caregiver understand the expression and distress of symptoms may lead to an overall improved experience for palliative advanced cancer patients.

Reference: McPherson CJ, Wilson KG, Lobchuk MM, Brajtman S. Family caregivers' assessment of symptoms in patients with advanced cancer: Concordance with patients and factors affecting accuracy. Journal of Pain and Symptom Management. 2008; 35(1): 70-82.

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