Although GPs were able to define their role in relation to assisting the carer, many defined this as the provision of more services for the care recipient and less often to referring caregivers on to psychological support services and community support services. In other words, addressing carer needs was equated to providing further services to enable to caregiver to fulfil their caring role. GPs although aware of caregiver emotional needs, were less able to effectively refer the carer on to support services.
Overall, most GPs in the study (80%) practised in the Perth Metropolitan region. A majority of GPs (60%) had spent at least 16 years as a GP and had been in their current location (practice setting) for less than ten years (60%). GPs had interests in the areas of mental health (13%), geriatric medicine (20%), paediatrics (10%) and women's health (13%).
GP perceptions of caregiver demographics
Of the total GP respondents, 75% believed that only 20% of their total number of patients had a family carer.
GPs said that they were frequently asked to refer caregivers onto services but this usually meant provision of information or referral onto Home Nursing Services (38%) or an Aged Care Assessment Team (ACAT) (27%). Psychiatric service referrals for carers accounted for 5% of total referrals.
GP ability to assist caregivers with their own needs
Although, 96% of GPs believed that they were able to assist with caregiver needs, Table demonstrates that this is largely in terms of information (89%) and referrals to services (86%) for the care recipient.
Types of assistance provided by GPs
In terms of psychological support for the carer, 77% said that they would provide counselling for carers. However, when asked to describe what they meant by 'counselling' this was described as 'lending a listening ear' by two GPs and 45% said that they would counsel the carer themselves. This is a concern because some carers may be in need of formal counselling sessions and are not being referred on to those services. In fact, further to this, only one GP in our sample had a formal counselling qualification.
Overall, 57% of GPs said that caregivers tended to talk about their own needs solely in relation to the care recipient. The remaining 42% said that they would tend to talk exclusively about the needs of the care recipient. Notwithstanding, 70% of family doctors said that they were asked for help with caregivers' emotional needs by caregivers themselves at some point. In response to this, GPs were asked if they would ever intervene when it became clear that the caregiver was experiencing extreme difficulty in coping. Two doctors highlighted the difficulties with accessing counselling services outside of the private sector as the main problem. Only 16% of GPs referred patients to community health centre counsellors and 14% to a clinical psychologist (private patients only).
Provision of emotional support
GPs preferred to assist with emotional needs by offering practical ways of helping with the duties of the caregiver. These needs were met by referring carers to community services Overall, twenty one doctors noted respite as a frequently offered means of helping caregivers cope with emotional burnout and ranged from a brief 'going for a walk' to a lengthier break when 'going on holiday'. Respite in terms of protecting the caregiver's health was also highlighted.
GPs noted the difficulties in addressing caregiver needs due to the fact that caregivers generally talk more about the care recipient than themselves. For this reason, doctors become adept at reading body language signals from caregivers as to when they are not coping well. For some doctors this makes it difficult to pinpoint caregiver problems. As one GP put it,
I take my cues from how they look and their body language tells me they need to be asked how they are feeling.
One GP believed that caregiver difficulties were often "couched in physical need" and had to be 'looked out for'. In fact only 9% of GPs said that caregivers had asked for a referral to psychological services. This was particularly true of psychological problems such as depression. Depression is also common amongst caregivers known to the GP. Assistance in dealing with depression usually involves referral to a counsellor or social worker and medication such as anti depressants.
The implication is that they are looking for medication help by not specifically saying that but it is implied. That is what they need referring to stress related problems.
Sometimes they just say they are depressed. It is a cry for help. They see no way of resolving the situation without being in a moral or ethical dilemma.
In relation to the GP's ability to respond to emotional needs of caregivers, some saw also their role as counsellor and mediator in conflict resolution between family members and care recipient. Some GPs said that for caregivers 'just letting a bit out" was enough in terms of counselling and for others it was a combination of GP counselling, psychologist and support group.
Counselling, support groups and sometimes medication and to talk to someone, who knows who has been through what they are going through.
One GP took this role further in advocating on behalf of the caregiver and reinforcing the value of their role. This included reassuring the caregiver that they are not alone and are "doing a good job". Three further GPs noted the need for recognition and acknowledging the caregiver for the role amongst the wider community.
Many caregivers were believed by GPs to struggle with the ongoing emotional demands of the caregiving role. Furthermore, a sense of guilt that many experience when they ask for assistance or admit that they are having difficulty in coping add to the emotional demands of the role. One GP highlighted the importance of providing the caregiver with the ability to set limits and establish boundaries in terms of time and input. This entails encouraging the caregiver to move beyond the feelings of guilt and acknowledging feelings such as resentment that the person whom the caregiver is caring for is no longer the same or parents feeling guilty and that the caregiver is in some way responsible when a child has a conduct disorder or drug problem. Part of the guilt for many caregivers was perceived by doctors to be a result of feelings of frustration over the caregiving role. One GP explained,
It impacts on family relationships and how a son or daughter relate to their partner. It impacts if behavioural changes in the patient are there in terms of partner not leaving the house and going to the day care centre. The care recipient wants them there all the time.