“It's a traumatic illness, traumatic to witness.”: A qualitative study of the experiences of bereaved family caregivers of patients with cutaneous T-cell lymphoma

Orlowska, D., Selman, L. E., Beynon, T., Radcliffe, E., Whittaker, S., Child, F. and Harding, R. (2018) “It's a traumatic illness, traumatic to witness.”: A qualitative study of the experiences of bereaved family caregivers of patients with cutaneous T-cell lymphoma. British Journal of Dermatology, 1-7. (doi:10.1111/bjd.16447).

Abstract

BackgroundCutaneous T‐cell lymphomas (CTCL) are rare cancers which can be difficult to diagnose, are incurable and adversely affect quality of life, particularly in advanced disease. Families often provide care, but little is known about their experiences or needs while caring for their relative with advanced disease or in bereavement.ObjectivesTo explore the experiences of bereaved family caregivers of patients with CTCL.MethodsSingle semi‐structured qualitative interviews were conducted with bereaved family caregivers of patients with CTCL recruited via a supra‐regional CTCL clinic. Transcribed interviews were analysed thematically, focusing on advanced disease, the approach of death and bereavement.ResultsFifteen carers of eleven deceased patients participated. Experiences clustered under four themes1 Complexity of care and medical intervention2 Carer roles in advanced CTCL3 Person vs. organisation‐centred care in advanced CTCL4 Knowing and not knowing: reflections on dying, death and bereavementCaregivers often had vivid recollections of the challenges of caring for their relative with advanced CTCL and some took on quasi‐professional roles as a result. Advanced disease made high demands on both organisational flexibility and family resources. For many caregivers, seeing disease progression was a prolonged and profoundly traumatic experience. The extent to which they were prepared for their relative's death and supported in bereavement was highly variable.Subthemes within each theme provide more detail about caregiver experiences.ConclusionsFamily caregivers should be considered part of the wider healthcare team, acknowledging their multiple roles and the challenges they encounter in looking after their relative with CTCL as the disease progresses. Their experiences highlight the importance of organisational flexibility and of good communication between health care providers in advanced CTCL.

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