ABSTRACT
Cancer patients, especially those who are in the final stages of life, have multifaceted needs including disease and treatment monitoring, symptom and pain management, medication administration and assistance with personal care, daily activities of living, and emotional distress (van Ryn et al., 2011). In private, for-profit health care systems, such as the ones found in the United States and in parts of Europe, much of this care has been moved from the in-patient arena to outpatient and ambulatory settings, with a shift in responsibility for the day-to-day care of patients from institutions to their families (Given, Gien & Kozachik, 2001; van Ryn et al., 2011). Informal caregivers in the global north are most likely to be spouses or female relatives who provide these services without pay and often without training or assistance from medical personnel. Hayman et al. (2001) estimate the financial value of the labor provided by US caregivers, 62% of whom are female, for elderly cancer patients at 1 billion dollars annually (p. 3223). Although this unpaid labor helps support the profitability of health systems, it comes at great costs to those providing the care, who are at higher risk of depression, cardiovascular disease and mortality (Schultz & Sherwood, 2008). Much of the strain of caregiving as well as the suffering of patients is intensified by the relative social isolation of the nuclear family. The care-giver often not only feels responsible for caring for the physical needs of the patient, but also for trying to help the patient emotionally and spiritually.
