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Steadying Oneself: Reflections of Family Care Managers in Advanced Cancer

Meeker, Mary Ann DNS, RN

Journal of Hospice & Palliative Nursing: July-August 2010 - Volume 12 - Issue 4 - p 236-244
doi: 10.1097/NJH.0b013e3181df4b81

Helping a family member who has cancer is a multifaceted responsibility. Forty adult surrogate decision makers for a family member experiencing advanced cancer were recruited for prospective interviews over the patient's care trajectory. Participants were those who would be responsible for healthcare decisions if the family member with cancer lost decision-making capacity. Our purpose was to examine how participants acquired and perceived their role and how they sustained themselves to carry out the role. Findings revealed that participants did not distinguish between their surrogate decision-making role and their broader care management role. Narratives of these family care managers revealed strategies they developed to help them carry out their role in ways aligned with their values and to steady themselves to avoid becoming overwhelmed. Three pairs of divergent strategies contributed to participants' capacity to meet the demands of the role over time. These paradoxical strategies included putting the care manager's own life on hold/maintaining essential personal activities, taking one day at a time/planning ahead, and being intentionally tolerant/setting limits. In addition to use of these stabilizing strategies, participants found that having a trusted other to talk with about their uncertainties was critical to sustaining them in their care management role.

Author Affiliation: Mary Ann Meeker, DNS, RN, Assistant Professor, School of Nursing, University at Buffalo, the State University of New York.

This study was funded by the National Institute of Nursing Research (1R15NR009026).

Address correspondence to Mary Ann Meeker, DNS, RN, School of Nursing, University at Buffalo, the State University of New York, 303 Wende Hall, 3435 Main St, Buffalo, NY 14214-8013 (

The author declare no conflict of interest

© 2010 The Hospice and Palliative Nurses Association