Function of the Team

• Provision of adequate information related to the patient’s health status and the caregiver’s own health risks, as well as health maintenance recommendations • Instruction on how to address common problems related to cancer treatment, such as nausea and vomiting, fever, delirium as well as depression and anger • Instruction on the management of family conflicts • Help in dealing with work-related and economic issues

The identification of the caregiver is generally a combined task for the nurse and the social worker. Being on the forefront of the patient’s assessment, the nurse is in the best position to recognise the person on whom the patient can rely most for support. In parallel, the social worker has the competence to recognise the assets and liabilities of the designed caregiver and to negotiate adequate solutions for the patient’s needs.

Correction of the caregiver’s shortcomings (e.g., finding a younger and independent person to aid an elderly and disabled caregiver) is the responsibility of the social workers.

The training of the caregiver is a combined task of the team. The physician and nurse are responsible for instructing the caregiver on how to manage common problems that may occur during cancer treatment; the social worker has the central task to guide the caregiver in the maintenance of his/ her own health and to work out social issues such as leave from work and help with childcare; the dietitian illustrates the most effective techniques to maintain the patient’s nutritional status; while the pharmacist is of assistance in assuring adherence to the treatment regimen and in minimising the potential complications of drugs.

All team members are responsible for praising the caregiver and highlighting the importance of caregiving. If the caregiver relies on faith for strength, the intervention of a member of the clergy may also be desirable.

The organisation of the team is not codified. In our institution, the H. Lee Moffitt Cancer Center, a geriatric team has been operating for 21 years. Though it has undergone some evolution, the basic organisation has remained the same (Fig. 3). All cancer patients aged 70 years and older are screened by a nurse for age-related problems. Patients who screen positive undergo a consultation by the whole team that reports the findings to the physician who is responsible for the initial treatment plans.

Figure 3 Organisation of the team at the H. Lee Moffitt Cancer Center and Research Institute in Tampa.