BackgroundIt is estimated that over 43 million friends or family members in the United States provide care for individuals with health-related support needs (American Association of Retired Persons Public Policy Institute & National Alliance for Caregiving, 2015). Caregivers of cancer patients frequently seek ways to provide supportive care for the patients’ disease and treatment-related symptoms, becoming involved in complex care activities. AimsThe aims of this research were to: 1) synthesize the state of the science relative to care activities performed by informal caregivers for cancer patients through a review of literature; 2) examine application and achievement of the elements of intervention fidelity within a research protocol for reflexology delivered by informal caregivers to advanced breast cancer patients; 3) analyze caregiver data for the effects of providing a care activity consisting of delivery of a symptom management intervention for breast cancer patients on caregiver psychological, physical, and social health outcomes; and 4) advance nursing science on the effects of informal caregiving by evaluating relationships between performance of a specific symptom management care activity and caregiver health outcomes, providing a level of detail not currently available in the literature.MethodsA three manuscript dissertation was completed, with each manuscript having its own methodology and results. Results1) The body of literature revealed a gap regarding the specific care activities performed by informal caregivers on behalf of patients with cancer, and the associated impact on the caregivers’ health outcomes. 2) Examining the National Institutes for Health Behavior Change Consortium elements of intervention fidelity in the protocol used to train informal caregivers to deliver reflexology to patients with breast cancer resulted in a scorecard for rating intervention fidelity. 3) The nature of the association between delivery of reflexology and caregiver depressive symptoms differed based on the relationship of the caregiver and the patient, with adult children caring for a parent experiencing significantly higher levels of depressive symptoms than control caregivers, and friends of the patient who provided reflexology reporting significantly lower levels of depressive symptoms. The physical health outcome of fatigue was found to decrease over time for all caregivers, but caregivers who provided reflexology reported significantly lower levels of fatigue than controls. Further, delivery of more sessions of reflexology was associated with significantly lower levels of reported fatigue.
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