**3. Interventions provided to the family caregivers by the primary healthcare professionals**

## **3.1 Psycho-educational interventions**

*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

patient and to his/her caregivers.

the patient with palliative care needs.

**2.2 Psycho-emotional domain**

*2.3.1 Family social support need*

*2.3.3 Family caregiver burden*

diseases and disabilities. Although a 60-minute duration of the evaluation may be a disadvantage, this tool offers a comprehensive analysis of the recipient, informing the home care provider about demographic characteristics, nutrition, health behaviours, types of diagnosis, functional and cognitive status and health instability (frailty). The Resident Assessment for Palliative Care (RAI-PC) is an instrument that evaluates the symptoms most commonly seen in palliative care patients: pain, dyspnoea, fatigue, mental capacity, cognition, overall physical tonus and capabilities for self-care. The needs of the palliative patient, his/her family and the caregivers are constantly changing, which leads to the need to regularly apply RAI-PC, both to the

The shorter duration of the evaluation by RAI-PC is appropriate for the palliative patient and his family. In addition, an important feature of this tool is its quality to evaluate the effectiveness of many types of interventions, establish a comparison between interventions and provide information for cost-effective management of

The old age, female gender, long-term provision of home care and type of illness

are predictive factors for the emotional stress of the family caregiver [16]. Early identification of high-risk psycho-emotional pressure enables effective interventions of GPs and community nurses. The Family Relationship Index (FRI) is the family relationship assessment tools, developed by Holahan and Moos in 1983. Through its three scales, it explores family cohesion, expressiveness and conflicts,

The support needs of family as caregiver refers to the environment/habitat, financial support, help for nursing techniques, the level of preparedness for the

The Oslo Social Assistance Scale (OSS-3) assesses people close to the patient, how much they are concerned about home care and who the recipient would ask for practical help if needed [18]. Another aspect of the social support refers to the financial well-being of the family. In 2006 Prawitz developed the Financial Distress/Financial Well-Being (IFDFW) tool which evaluates the perception and concerns about family financial status. The low score shows the high level of finan-

The Preparedness for Caregiving Scale (PCS) described by Archbold, Stewart, Greenlick and Harvath, in 1990, is an instrument with eight items that ask family caregivers how much they are well prepared for the challenges of caregiving. The

The caregiver burden is a negative experience perceived by the person involved in the long-term home care. The Burden Scale for Family Caregivers (BSFC) is a

helping the professional home care team and collaboration [17].

caregiver role and educational needs for the caregiving process.

cial distress, leading to an increasing deterioration of health [19].

lower score signifies the poor preparedness for the caregiver role [20].

*2.3.2 Preparedness of family for the caregiver role*

**2.3 Assessing the need for family support as home care provider**

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The psycho-educational interventions provided to the family caregivers are focused on the preparedness of family for the caregiving role, help for emotional reset, encouragement to identify the positive aspects of this experience, promotion of self-care, respite care and advising for new problem-solving strategies. There are different forms of psycho-educational intervention: individual session face-toface, focus groups and e-learning programme with an online professional teacher. A useful method is the family meeting, having the following advantages: provides training of caregiver for proper nursing technics, facilitates discussions about the disease' prognosis, updates the home care goals and establishes a concordance between care goals and the recipient's desires. In addition, it is a good moment to share the patient's preferences, to reduce stress, anxiety, depression and emotional changes in end-of-life care [21]. The principles for conducting family meetings are clarifying targets of care, refreshing the knowledge about the disease, anticipating future challenges and offering solutions in accordance with the family needs [22].

#### **3.2 Supportive interventions**

Social support is defined as the existence or availability of people on whom individuals or families can rely on difficult times. The support interventions for family caregivers include groups or individual sessions, being conducted by professionals. Group-based support is the most common form wherein the whole family participates, including the patient. In this method experiences are shared, leading to positive changes regarding the personal confidence, acceptance of the family caregiver role and adoption of new coping skills [23]. Applying flexible and individualized forms of support interventions helps reduce the burden of caregivers and increases the knowledge about home care and ability to cope with difficult situations [24].
