Table 1 Items of the risk and needs assessment form for caregiversa
What is your relation to you ill relative? | ||||
|---|---|---|---|---|
Do you have children in your household that you are (partly) responsible for? | ||||
Not at all | A little | Some | A lot | |
Do you need information about your relative’s disease and/or your current situation? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you and your relative need further help to alleviate disease symptoms, including giving medicine? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you need information about who to contact if you need help, including at night? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you need help to clarify economic, legal, housing or work-related issues? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you need knowledge about what to expect in the course of your relative’s disease? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you need support to talk with your relative about his/her disease and its consequences? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you feel as if you lack support from family and friends? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you feel overwhelmed by practical tasks or tasks in relation to caring for your ill relative? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you need help to take breaks from caring for your ill relative, or taking care of your own needs? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you need help to cope with your own thoughts, feelings or worries? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you have thoughts about religion/spirituality or life and death, that you feel you need to talk about? | ⎕ | ⎕ | ⎕ | ⎕ |
Do you feel depressed? | ⎕ | ⎕ | ⎕ | ⎕ |
Have you experienced significant losses earlier in your life that places a strain on you now? (e.g. regarding health, job, divorce, or death?) | ⎕ | ⎕ | ⎕ | ⎕ |
Do you suffer from a mental illness (e.g. depression, stress or anxiety) that has been diagnosed by a medical doctor? | Yes ⎕ | No ⎕ | ||
If yes, which illness? | ||||