Care Anxiety Research Articles

Cultural differences are reflected in variables associated with carer burden in FTD: a comparison study between India and Australia.

There is great need to understand variables behind carer burden, especially in FTD. Carer burden is a complex construct, and its factors are likely to vary depending on the type of dementia, carer characteristics and cultural background.OBJECTIVEThe present study aimed to compare profiles and severity of carer burden, depression, anxiety and stress in carers of FTD patients in India in comparison to Australia; to investigate which carer variables are associated with carer burden in each country.METHODSData of 138 participants (69 dyads of carers-patients) from India and Australia (India, n=31; Australia, n=38). Carer burden was assessed with the short Zarit Burden Inventory; carer depression, anxiety and stress were measured with the Depression, Anxiety and Stress-21. Dementia severity was determined with the Frontotemporal Dementia Rating Scale (FTD-FRS), and a range of demographic variables regarding the carer and patient were also obtained.RESULTSOverall, levels of carer burden were not significantly different across India and Australia, despite more hours delivering care and higher dementia severity in India. Variables associated with burden, however, differed between countries, with carer depression, anxiety and stress strongly associated with burden in India. By contrast, depression, stress, and dementia severity were associated with burden in Australia.CONCLUSIONThis study demonstrated that variables associated with carer burden in FTD differ between cultures. Consequently, cultural considerations should be taken into account when planning for interventions to reduce burden. This study suggests that addressing carers' skills and coping mechanisms are likely to result in more efficacious outcomes than targeting patient symptoms alone.

Anxiety and depression in incident stroke survivors and their carers in rural Tanzania: A case-control follow-up study over five years

AimsTo quantify the extent and nature of anxiety and depression in a representative cohort of stroke survivors and their carers in rural Tanzania. DesignA cross-sectional design was used and stroke cases were followed up at 6–60 months post-stroke. Levels of anxiety and depression in stroke survivors, their carers (for physically dependent stroke survivors) and age- and sex-matched controls were assessed using the hospital anxiety and depression (HAD) scale. Other data collected included age, sex, time elapsed since stroke, quality of life, cognitive function, level of disability and socioeconomic status. ResultsLevels of depression seen in our cohort of stroke survivors (53.0%) are high compared to data from the developed and developing world. Anxiety levels (21.6%) are similar to published data. Stroke survivors (n=58, full data set n=51) and carers (n=27) were significantly more anxious than controls (n=58), whereas levels of depression were similar across all three groups. High stroke survivor HAD scores correlated with lower scores in physical health, psychological health and environment sections of the WHOQOL-Bref. Increased carer anxiety and depression were associated with reduced informant-reported levels of cognitive function in stroke survivors. ConclusionsTo our knowledge this is the first long term study of incident stroke cases in sub-Saharan Africa which has investigated the psychological health of stroke survivors and their carers. Our study highlights the growing need to develop community rehabilitation services in the developing world, which address both physical and psychological morbidity.

Support for Older People with COPD in Community Settings: A Systematic Review of Qualitative Research.

There are an estimated three million people affected by Chronic Obstructive Pulmonary Disease (COPD) in the UK with only about 900,000 of these being diagnosed according to the Healthcare Commission, and prevalence is increasing. Significant progress has been made in respect of treatment and management of the disease. However, there is limited evidence related to the perspective of those with COPD despite an acknowledgement that lung function, as determined by spirometry, does not necessarily equate with pulmonary disease and subsequent functional level or disability. The impact of COPD on patients, their family, carers and healthcare services demands that better ill health prevention and disease maintenance strategies be employed. The objective was to explore the common and shared experiences of those in caring partnership for patients with COPD receiving care and support in their community. For this review, the definition of support takes the view that support relates to 'any activity or intervention aimed at improving or maintaining the health status of a patient with COPD'. The review focused on the experiences of patients, carers, family members, nurses and doctors involved in providing support to patients with COPD in their own home. Patients aged 65 years and over were included.The review considered studies that represented patient, carer, nursing and medical staff experiences and perceptions of support relating to COPD.The review considered evidence from qualitative research including phenomenology, grounded theory, and descriptive studies, where support for COPD in a community context was the focus. The search set out to find published studies in English from 1990-2010. The studies were appraised and findings extracted using the JBI critical appraisal tool for qualitative research. Three reviewers appraised the studies independently. 72 studies were critically appraised and 39 met the inclusion criteria. Findings from included papers were aggregated, categorised and synthesised. If those with COPD received more consistent support in relation to information, rehabilitation, end of life care and other service provision then their quality of life could be enhanced.Better planned and more integrated support for home based care around self-care/management and in managing exacerbations can reduce patient and carer anxiety and distress related to COPD.Individualisation of care, which is not based on the patient's 'disease state' (i.e. physical parameters) but on assessed need, is a necessary part of care for those with COPD.

Support for Older People with COPD in Community Settings: A Systematic Review of Qualitative Research

There are an estimated three million people affected by Chronic Obstructive Pulmonary Disease (COPD) in the UK with only about 900,000 of these being diagnosed according to the Healthcare Commission, and prevalence is increasing. Significant progress has been made in respect of treatment and management of the disease. However, there is limited evidence related to the perspective of those with COPD despite an acknowledgement that lung function, as determined by spirometry, does not necessarily equate with pulmonary disease and subsequent functional level or disability. The impact of COPD on patients, their family, carers and healthcare services demands that better ill health prevention and disease maintenance strategies be employed.The objective was to explore the common and shared experiences of those in caring partnership for patients with COPD receiving care and support in their community.For this review, the definition of support takes the view that support relates to 'any activity or intervention aimed at improving or maintaining the health status of a patient with COPD'.The review focused on the experiences of patients, carers, family members, nurses and doctors involved in providing support to patients with COPD in their own home. Patients aged 65 years and over were included.The review considered studies that represented patient, carer, nursing and medical staff experiences and perceptions of support relating to COPD.The review considered evidence from qualitative research including phenomenology, grounded theory, and descriptive studies, where support for COPD in a community context was the focus.The search set out to find published studies in English from 1990-2010.The studies were appraised and findings extracted using the JBI critical appraisal tool for qualitative research. Three reviewers appraised the studies independently. 72 studies were critically appraised and 39 met the inclusion criteria.Findings from included papers were aggregated, categorised and synthesised.If those with COPD received more consistent support in relation to information, rehabilitation, end of life care and other service provision then their quality of life could be enhanced.Better planned and more integrated support for home based care around self-care/management and in managing exacerbations can reduce patient and carer anxiety and distress related to COPD.Individualisation of care, which is not based on the patient's 'disease state' (i.e. physical parameters) but on assessed need, is a necessary part of care for those with COPD.

Ansiedad y depresión en cuidadores de pacientes dependientes

ObjectiveTo determine the prevalence of depression and anxiety in main carers of dependent patients as defined by the Dependent Care Law 39/2006. Material and methodsWe selected 294 main carers of dependent patients as defined by Law 39/2006, and performed a descriptive, cross-sectional and multi-centre study.They were recruited during the first semester of 2009 in 8 urban centres and 2 rural ones in the Communities of Andalusia and Murcia.We measured levels of anxiety and depression using the Hamilton scale, the social support by means of the Duke-UNK scale, sociodemographic, medical variables and associated with the support to the dependent person.The Chi-squared (χ), Wilcoxon and Student t tests were used to describe the data. Multivariate analysis was performed on the most significant data. ResultsA total of 254 carers showed anxiety (86%) (95% CI: 82.47-90.31%) and depression 191 (65%) (95% CI: 59.51 – 70.41%).The presence of anxiety was statistically significant (P=.043) when associated to: being an unpaid carer, low social support, previous diagnosis of anxiety and depression, taking of psychiatric drugs, and diagnosis of depression using the Hamilton depression scale.The depression presence of depression is associated with: being an unpaid carer, family relationship, previous diagnosis of anxiety and depression, taking of psychiatric drugs, and with an anxiety diagnosis according to the Hamilton scale.No statistically significant differences were detected in the association between levels of dependency and the appearance of depression and/or anxiety. ConclusionsThe prevalence of depression and anxiety in the carers of dependent patients is significantly greater than in the general population. The greater the social support the lower the prevalence of these disorders.

Triage: An innovation in practice

As the increase in demand for access to specialist palliative care services continues, methods to prioritise patients and carers with the greatest need becomes of increasing importance.AimThe aim of the...

A description of multiple family workshops for carers of people with anorexia nervosa

Carers of people with eating disorders are uncertain about how best to help and express the need for information. Fifty per cent of carers (usually parents) exhibit clinically significant anxiety and/or depression. This may result from a difficulty coping with the manifestations of anorexia nervosa (AN) in the sufferer. In turn, eating disorder symptoms can be maintained by family reactions to the illness. Thus, carer's own symptoms, plus their uncertainty about how to help, impinge upon the AN sufferer, exacerbating their symptoms and behaviours. In this paper, we describe an intervention which uses cognitive behavioural therapy principles to alleviate carer's depression and anxiety and motivational interviewing to target behaviours that maintain eating disorder symptoms, for example high expressed emotion and poor communication. This is given in the form of an educational workshop for two families.

Coping strategies and psychological morbidity in family carers of people with dementia: A systematic review and meta-analysis

Carers for people with dementia experience high levels of anxiety and depression. Coping style has been associated with carer anxiety and depression. We systematically reviewed studies examining the relationships between coping and anxiety or depression among carers of people with dementia. We rated study validity using standardised checklists. We calculated weighted mean correlations (WMC) for the relationships between coping and psychological morbidity, using random effects meta-analyses. We included 35 studies. Dysfunctional coping correlated with higher levels of anxiety (WMC=0.39, 95% CI 0.28-0.50; N=688) and depression (0.46, 0.36-0.56; N=1428) cross-sectionally, and with depression 6 and 12months later (0.32, 0.10-0.54; N=143). Emotional support and acceptance-based coping correlated with less anxiety (-0.22, 95% CI -0.26 to -0.18; N=628) and depression (-0.20, -0.28 to -0.11; N=848) cross-sectionally; and predicted anxiety and depression a year later in the only study to measure this. Solution-focused coping did not correlate significantly with psychological morbidity. Just over a quarter of the identified studies provided extractable data for meta-analysis, including only two longitudinal studies. There is good evidence that using more dysfunctional, and less emotional support and acceptance-based coping styles are associated with more anxiety and depression cross-sectionally, and there is preliminary evidence from longitudinal studies that they predict this morbidity. Our findings would support the development of psychological interventions for carers that aim to modify coping style.

Unmet needs, quality of life and support networks of people with dementia living at home

BackgroundThere is lack of evidence about the unmet needs of people with dementia (PWD) living at home and the predictors of high levels of unmet needs. The main aim of this study was to identify the relationship between unmet needs, social networks and quality of life of PWD living at home.MethodsOne hundred and fifty two community dwelling PWD and 128 carers were interviewed about PWD's needs, social networks, quality of life and other functional and psychological factors. All the interviews with PWD were carried out at their homes. Interviews with carers were undertaken either at PWD's home, their own home or at the health centre. Whenever possible, PWD and carers were interviewed separately. The data collection took place between November 2005 and July 2007. The majority of participants (129, 84.9%) were recruited from National Health Services (NHS) and the rest (23, 15.1%) were recruited from other organisations such as social services and voluntary organizations in the UK.ResultsThe most frequent unmet needs for PWD were daytime activities (77, 50.7%), company (60, 39.5%), and help with psychological distress (47, 30.9%). Higher number of behavioural and psychological symptoms, low-community involvement social networks, having a younger carer and higher carer's anxiety were found to be predictors of higher unmet needs in PWD. Social networks and behavioural and psychological symptoms had an indirect effect on PWD's self-rated quality of life through unmet needs.ConclusionsInterventions aiming to reduce unmet needs, through the treatment of behavioural and psychological symptoms and the involvement of PWD in the community, would potentially improve PWD's quality of life.

An exploratory study of anxiety in carers of stroke survivors

To investigate anxiety in informal carers of stroke survivors in the first three months after discharge. Informal carers, also called caregivers, play a vital role in supporting stroke survivors. However, caring for stroke survivors can have adverse consequences amongst carers such as burden, stress and reduced quality of life. Emotional distress is also commonly reported but anxiety has received less attention than depression. Prospective, longitudinal, descriptive study. Forty-five carers completed the Hospital Anxiety and Depression Scale on two occasions - within one month and at three months after discharge from stroke and rehabilitation units. Carers were more likely to have scores indicating anxiety than depression. In the first month, half the carers (51·1%) scored in the cut-off for anxiety and a third were in the cut-off for depression (31·1%). At three months, the picture was very similar with nearly identical proportions in the anxious and depressed categories (48·9% and 28·9%, respectively). Changes in numbers of cases of anxiety and depression and in mean anxiety scores were non-significant but there was a significant decrease in depression scores (p=0·048). Fourteen carers (31·1%) at one month and eleven (24·4%) at three months fell into both anxious and depressed categories. Anxiety is a relatively neglected emotional outcome in stroke carers. Our study suggests anxiety is an important issue very early in caring whilst other research suggests it remains prevalent for many months. Given the significant role carers play in rehabilitation of stroke survivors, greater recognition of their emotional state is required. Further, longitudinal research with larger sample sizes from a range of geographical areas and improved understanding of factors associated with anxiety is needed. Nurses working in the community are ideally placed to identify and support carers suffering from anxiety.

Identifying needs, burden, and distress of carers of people with Frontotemporal dementia compared to Alzheimer’s disease

The literature on carers of people with Frontotemporal dementia (FTD) is negligible compared to the vast literature on carers of people with Alzheimer’s disease (AD), and little research has compared the two groups. Research has mainly focused on identifying the behavioural characteristics of people with FTD or AD. The impact of these behaviours on the psychological well-being of carers of people with FTD is relatively unexplored. This study investigated the needs, burden, and extent of depression and anxiety in carers of people with FTD ( n = 30) compared to carers of people with AD ( n = 30). Findings indicated that needs of carers of people with FTD were significantly higher than those of the carers of people with AD. The elevated needs were related to the younger onset of FTD, financial dissatisfaction, typical FTD characteristics, and access to appropriate services, information and support. Results also suggested that female carers were more likely to report a greater severity and impact of disruptive symptoms associated with FTD. No significant differences were found between the two groups on carers’ levels of burden, depression or anxiety. In order to address the needs of carers of people with FTD, we recommend specific educational and support programs, raising community awareness and understanding, and tailoring existing domiciliary services and activities for people with FTD.

The experiences of children with learning disablilities, their carers and staff during a hospital admission

Accessible summary Disabled children and their carers were asked what it was like to stay in hospital. They said they felt worried and the hospital was not always ready for them. They also said it was helpful if the child’s carer could be there during a hospital stay and it is better when the child has their own room. This research will help hospital make changes to make staying in hospital as positive as possible. SummaryGovernment policy is that people with learning disabilities should have their healthcare needs met by mainstream services. This study interviewed the carers of 13 children with learning disabilities admitted to hospital for a period longer than 24 h. Nursing staff and two children were also interviewed. Five themes were identified as having a significant impact: (i) child, carer and staff anxiety, (ii) preparedness for the admission, (iii) difficulties managing the child’s behaviour, (iv) carer presence during the admission and (v) ward environment. This study presents edited responses from children, their carers and ward staff and identifies areas for service improvement. These include an emphasis on the value of emotional support, ensuring staff are prepared for hospital admission, agreeing strategies for supporting the child’s behaviour, clarifying carers and staff roles during an admission, ensuring the child has an individual room if required. Study limitations are discussed and directions for future research recommended.

The determinants of family carers' abusive behaviour to people with dementia: Results of the CARD study

Background Although dementia and elder abuse prevention are political priorities, there are no evidence-based interventions to reduce abuse by family carers. We have limited understanding of why some family carers, but not others in similar circumstances, behave abusively. We aimed to test our hypothesis, that more anxious dementia carers report more abusive behaviours, and dysfunctional coping strategies and carer burden mediate this relationship. Method We interviewed 220 family/friend dementia carers from Essex and London Community Mental Health Teams. We used the revised Modified Conflict Tactics Scale to measure abuse. Results More anxious and depressed carers reported more abuse; this relationship was mediated by using dysfunctional coping strategies and higher burden. Abuse was predicted by: spending more hours caring, experiencing more abusive behaviour from care recipients and higher burden. Limitations This was a cross-sectional study so we cannot confirm directions of causality. While many carers were willing to report abusive actions, some may not have been and our numbers may be an underestimate. Conclusion Anxious and depressed carers are particularly likely to report abusive behaviour when asked. Testing interventions directed at reducing carer anxiety, depression or changing unhelpful coping strategies, and/or reducing care recipient aggression where possible, is a logical and urgent next step.

Keeping In Touch Everyday (KITE) project: developing assistive technologies with people with dementia and their carers to promote independence

The role of technology to facilitate independent living for people with dementia is not fully realized, with initial attempts (e.g. tracking devices) being considered unacceptable from a practical and ethical perspective. The aim of this study is to create acceptable and effective prototype technologies to facilitate independence for people with dementia through a user-centered design process involving them and their carers. The study comprised a three-stage participatory design process: scoping stage (five focus groups, 10 people with dementia and 11 carers); participatory design stage (five workshops, 22 participants) and prototype development stage (four meetings with two people with dementia and one carer). Focus groups and workshops were digitally recorded, fully transcribed and subjected to constant comparative analysis. People with mild to moderate dementia enjoy a variety of activities both on their own and with their families; however, concerns included getting lost, a loss of confidence with curtailment of usual activities, and carer anxiety. Existing technologies (mobile phones) were used intermittently. Participants felt strongly that future devices should be disguised and be integrated easily into their daily routines. Suggested areas for functional improvement included two-way communications, flexibility of function as the illness progresses, and something to "guide" them home when out walking or driving. Attention should also be focused on minimizing the size, weight and visibility of devices to reduce stigmatization. Prototypes for two devices (armband and electronic notepad) were developed. The study showed that involving people with dementia in the process of participatory design is feasible and could lead to devices which are more acceptable and relevant to their needs.

A reassuring presence: An evaluation of Bradford District Hospice at Home service.

BackgroundWithin the United Kingdom, a developing role for primary care services in cancer and palliative care has resulted in an increase in palliative home care teams. The provision of professional care in the home setting seeks to provide necessary services and enhanced choice for patients whose preference is to die at home.A mismatch between patient preference for home death and the actual number of people who died at home was identified within Bradford, the locality of this study. In response to this mismatch, and reflecting the policy environment of wishing to enhance community service provision, the four Primary Care Trusts (PCTs) in the city sought to offer support to patients who wished to remain in their own homes through the final stages of a terminal illness. To offer this support they set up a dedicated hospice at home team. This would provide services and support for patients in achieving a dignified, symptom free and peaceful death, allowing families to maximise time spent together. The aim of the study was to evaluate the Bradford hospice at home service from the perspective of carers, nurses and General Practitioners.MethodsPostal questionnaires were sent to carers (n = 289), district nurses (n = 508) and GP's (n = 444) using Bradford's hospice at home service. Resulting quantitative data was analysed using the Statical Package for Social Sciences (SPSS) and qualitative data was analysed using grounded theory techniques.ResultsThe data from carers, district nurses and GPs provide general support for the Bradford hospice at home service. Carers valued highly the opportunity to 'fulfil a promise' to the individual who wished to be cared for at home. District nurses and GPs cited the positive impact of access to specialist expertise. This was a 'reassuring presence' for primary healthcare teams and offered 'relief of carer anxiety' by providing prompt, accessible and sensitive care.ConclusionCarers and health professionals welcomed the increased possibility of patients being cared for at home. The study identified the need to focus on improving skill levels of staff and on ensuring continuity of care.

Attachment style and anxiety in carers of people with Alzheimer's disease: results from the LASER-AD study

Preliminary evidence indicates that the quality of the carer-care recipient relationship predicts those carers most at risk from anxiety. Attachment style is related to higher carer burden, psychological morbidity and increased care recipient institutionalization. We tested, for the first time, the hypothesis that carer burden and the coping strategies used mediate a relationship between attachment style and anxiety. We interviewed 83 people with Alzheimer's disease and their family carers, originally recruited for a larger community study. Carers filled in a validated measure about their attachment style, the Hospital Anxiety and Depression Scale, the COPE to measure coping strategies, and the Zarit-Burden interview. More avoidant attachment (beta = 0.28) and less secure attachment (beta = -0.32) predicted anxiety. After adding coping strategies to the equation, the relationship with avoidant attachment (beta = 0.15) was no longer significant, and that with less secure attachment was reduced (beta = -0.23). A well-fitting structural equation model supported our finding that dysfunctional coping mediated the relationship between attachment style and anxiety. Carers who were less secure or more avoidantly attached reported higher anxiety. Interventions that aim to modify coping strategies have shown promise in reducing carer anxiety. Our finding that coping strategies also appear partially to explain the excess of anxiety among less securely attached carers suggests they are likely to benefit from such interventions.

Impact and Influences on Caregiver Outcomes at One Year Post-Stroke

Background and Purpose: Four outcome measures of carer stress and coping at one year post-stroke were identified: carer general health, anxiety, depression and perception of stress. Methods: Each outcome was assessed using valid and reliable instruments. In addition, we collected demographic data from both carers and patients which could reasonably be expected to influence carer stress and coping (e.g. age, deprivation levels) as well as information specific to the caring role. Results: Carers were found to be more anxious than previously reported. Neither satisfaction with caring nor the adoption of helpful coping strategies were associated with positive carer outcomes but, nevertheless, carers were not reluctant to care. The SF-36 is a useful predictor of carer stress, in particular the vitality score. Conclusions: Patient data are not sufficient to predict carer general health at one year. At one year, both patients and carers are more anxious than depressed. And there may be a group of patients and carers who can be characterised as borderline anxious and/or depressed and who warrant specific attention to prevent carer burnout.

The relationship between patient characteristics and carer psychological status in home palliative cancer care.

Despite being both providers and intended recipients of care, informal carers in cancer palliative care report high levels of distress and unmet needs. In order to develop supportive care strategies, this analysis aimed to identify which patient characteristics contribute to carer psychological distress and which coping strategies carers employ. Informal carers attending two home palliative care services gave cross-sectional data regarding patient characteristics and their own psychological status using standardised measures. Multivariate analyses were performed for each dependent carer psychological measure, with patient characteristics as independent variables (adjusted for carer age and gender). Forty-three carers participated. Greater patient distress was associated with carer anxiety (b value: magnitude of the effect) (b=0.31, p=0.07), and both patient psychological status (b=0.37, p=0.02) and pain (b=0.29, p=0.09) were associated with carer psychological morbidity. Carer burden was associated with patient psychological distress (b=0.35, p=0.03) and pain (b=0.29, p=0.08). Carer avoidance/emotion-focused cognitive coping strategies were associated with patient physical function (b=0.34, p=0.04), and cognitive problem-focused coping was associated with patient symptoms (b=0.28, p=0.06) and physical function (b=0.29, p=0.05). Adequate provision of patient psychological interventions and effective pain education and control are needed in order to improve carers' psychological health. Patient characteristics are associated with apparently opposing forms of carers' coping (i.e. both avoidance and engagement), demonstrating the importance of interventions addressing a range of coping responses. Further research is needed to understand why carers employ problem-focused coping in response to symptoms but not to pain. Evidence-based interventions for informal carers are urgently needed but must be delivered in the context of optimal patient pain and symptom control.

Implicación familiar en los cuidados del paciente crítico

Objectives. Implementation and valuation of the family member participation in the critically ill patient care.Methodology. Experimental, longitudinal and prospective study, temporal series, with a random control group. This family implication program will be valued according to three dependent parameters: patient, family carer and nursing staff.cognitive state, measured by using the Mini-mental state examination test. Family visitor: family principal carer anxiety state levels, measured using STAI test. Nursing staff: nurses' beliefs about changes introduced in the ICU, valued using attitude Likert type scale.Hypothesis. A family participation program design and implementation in the basic care in the critic patient has positive and significantly influence in the patient, family career and nursing staff.Results. The sample was of 117 cases; 49 in control group, 49 in experimental group and 19 no valid. The STAI test obtained in the experimental group a mean of 23.57 against control group of 31.22 (p <.005). Minimental test was a mean of 23.43 for control group and 24.61 for experimental group. Nursing staff thinks the open visit provides emotional support (p =.005). Although they think the pain perception is great with the family presence (p =.013). The family satisfaction grows up (p =.026). Nursing staff thinks they are more prepared to have a better relationship with the family (p =.021). The belief that the open visit produces a bigger physics and psychic burden is decreasing (p =.03).Conclusions. The anxiety levels are decreasing significantly. The cognitive state is not modified in the experimental group against the control group after the intervention. The nursing staff believes are better respect the open visit.

Predictors of family anxiety in the weeks before bereavement

There has been little research to date on the factors which predict high anxiety in family members or carers before bereavement. Our study used data on 302 patients for whom the family's anxiety had been recorded by cancer palliative care teams in the last weeks of the patient's life. Variables known at the time of the patient's referral to the teams were entered into a discriminant analysis. A predictive function with a sensitivity of 0.75 and a specificity of 0.51 identified those families whose anxiety was rated as severe (3–4 on a scale of 0–4) during the month before the patient's death. Important predictors were: whether the family member was a spouse, a diagnosis of breast cancer, young age, the time from diagnosis and low patient mobility. There was a small significant correlation between a longer time in palliative care and lower family anxiety. The predictive model could be used by oncologists to identify cases where greater psychological support will be needed.