The focus for this thesis has been significant others to patients with a
life threatening cancer disease including patients enrolled in palliative
homecare units and patients diagnosed with inoperable lung cancer. In
today s more outpatient oriented health care context the significant
others in these populations often become caregivers to their relatives
with cancer. The studies in the thesis are mostly concerned with the
interactions that occur between the significant other and the patient.
The overall aim was to explore different aspects of significant others
situation as caregivers in the process that arise when a close person has
been diagnosed with at life threatening cancer disease. The first
qualitative study aimed to prospectively explore how family caregivers
reason about their expectations of providing end-of-life care at home for
relatives with cancer. Two themes were generated from interviews with the
significant others; one concerned the role transition into becoming a
caregiver and the other the transition into a new life situation of the
significant other. Significant others described themselves as bearing the
primary responsibility for the care of the patient. They were found to
have many concerns regarding communication of emotions about their own
situation but seemed to have few expected sources of support in these
concerns. Normally often the patient would have been the intimate
confidant but in this situation normal communication patterns were
disrupted. Professionals were expected to support primarily as
consultants in direct care related tasks. In the second and third study
dyadic assessment from significant others and patients were used to
elevate significant others ability to identify and evaluate central
problems and symptoms in persons with lung cancer, and in addition to
investigate factors that may influence this ability. Results showed that
the levels of agreement between significant others and patients
assessments of the patients functions and symptoms were fair to good, but
that significant others consistently rated the patients symptoms higher
and functioning lower than the patients did. These discrepancies were
most substantial in ratings of fatigue, emotional funcitoning, global
health/quality of life. Factors found to influence agreement in those
dimensions were, gender, patient age and significant others
self-reported lack of family support, health problems and caregiver
esteem. It was also found that emotional functioning and fatigue were the
only significant predictors of the patients overall quality of life in
both the patients and the significant others assessments. The fourth
study was intiated to explore significant others relational functioning
to a person with lung cancer and development in relational functioning
during the first year after the patients diagnosis. In a sample of 91
significant others, data was collected on four occasions. Fifty-two
percent of significant others reported change in relational functioning
during disease trajectory. The most common change in relational
functioning was either a linear change in a negative direction (49%) or a
non-linear change with a temporary descending curve (26%), showing that
change toward a more problematic relationship was most common. In this
thesis it is concludes that communication and intimacy in the
relationship between significant others and patients, particularly
regarding emotional concerns, may have implications for the significant
others transition into becoming a caregiver for a relative with a life
threatening cancer disease