Caregiver training for a therapeutic alliance in palliative home care.

15 Background: Caregiver (CG) presence and efficiency are crucial in providing a palliative home care (PC) program. The Aims of this study were: 1. to investigate educational needs expressed by caregivers (CGs) of advanced cancer patients (pts) in home care service (HCS) of our Institution; 2. to develop a guide to support PC team; 3. to evaluate the impact of this tool on CGs skills. Methods: Based on published data, we identified 3 areas of interest (therapy administration (TA), care, symptoms management) and 17 specific topics: mobilization, hygiene, skin/mouth care, dysphagia, xerostomia, bowel function, diuresis/urinary catheter care, feeding, and some symptoms. We then prepared a guide with clear information regarding each topic. We mainly focused on symptoms, in particular on pain. We elaborated instructions on TA and administration routes (techniques for subcutaneous (SC) injection/infusion with elastomeric pump). Use of short tips, images, pictures, and cartoons made the guide very accessible. From July to September 2017 the guide was provided to 24 CGs, 8 (33%) men, 16 (66%) women. 12 CGs (50%) were pts’ partners, 10 (41.6%) son/daughter, 1 relative (4.1%), 1 formal CG (4.1%). Several educational interventions (EI) were adopted to reinforce learning according to the pt conditions and CGs’ needs. The effectiveness of EI was retrospectively assessed from clinical records. Results: We offered 218 EI to 24 CGs, with an average of 9 per CG, and within a range of 6-13 per CG. Topics most frequently addressed were: SC injection technique (100%), skin care (21 CGs, 87.5%), pain care (21 CGs, 87.5%), feeding (20 CGs, 83.3%), mobilization techniques (17 CGs, 70.8%). We also performed 16 EI repetitions on 11 CGs (45.8%) on ≥1 topics: 4 for mobilization, 2 for pain, dysphagia, SC injection, feeding, bowel function, 2 for other topics.Assessment of EI effectiveness showed great CG receptivity, with 93% of interventions followed by a change in CG behaviour thereafter. Conclusions: The proposed intervention, the use of a simple guide to reinforce EI, is feasible, well accepted and appears to improve CG’s ability in providing home PC. Based on these results, we added a section dedicated to EI for CGs into the new electronic record of our HCS, introduced since January 2018.