Making a Difference for Family Caregivers of Hospice Patients: Qualitative Evaluation of a Problem Solving Intervention

Background and Purpose: An abundance of research has established that family members providing care for a dying individual are at risk for compromised psychological well being and quality of life. A small but growing evidence base supports the efficacy of structured problem solving interventions in improving psychological outcomes and overall quality of life of family caregivers of individuals receiving hospice services. In this session, researchers will present findings from the qualitative arm of a mixed methods evaluation of a problem solving intervention delivered by social workers and nurses to family caregivers of hospice patients. Funded by an R21 grant from the National Institute of Nursing Research, the study was guided by the following overarching research question: Which processes lead to improvements in psychological well being and quality of life among family caregivers participating in a structured problem solving intervention for hospice service recipients? Methods: In partnership with two hospice agencies located in the Pacific Northwest region of the United States, researchers recruited 126 informal caregivers to participate in a standardized problem solving intervention based on D'Zurilla and Nezu's body of research on problem solving therapies. Each participant met individually with a masters-prepared social worker or nurse for three sessions during which they learned and executed a five-step approach to solving problems encountered during caregiving. Caregivers who completed the full study protocol participated in in-depth, semi-structured exit interviews during which broad, open-ended questions were used to encourage participants to reflect on all stages of the intervention and to provide insight into their involvement in the project. Researchers conducted a thematic analysis of the qualitative data generated during these interviews, elucidating the processes that led to observed improvements in psychological outcomes and quality of life for caregivers. Results: Thematic analysis of qualitative data resulted in the identification of five themes describing processes deemed by study participants to be central to their experience of the problem solving intervention: reflecting on caregiving, structuring problem solving efforts, partnering with an interventionist, resolving problems, and gaining confidence and control. To varying degrees, the processes described within each theme explain the changes caregivers underwent while participating in the problem solving intervention that ultimately led to improved well being and quality of life. Conclusions and Implications: These study findings have immediate and direct implications for advancing hospice social work practice with family caregivers. Findings revealed the mechanisms by which informal hospice caregivers benefited from the problem solving intervention and provided additional support for the adoption of structured problem solving interventions into standard hospice social work services.