• Rachel McCauley, Karen Ryan, Regina McQuillan, and Geraldine Foley.
• Discipline of Occupational Therapy, School of Medicine (R.McC, G.F.), Trinity College Dublin, Dublin, Ireland.
• J Pain Symptom Manage. 2023 Nov 1; 66 (5): 570577570-577.

ContextPatients and informal caregivers in palliative care can reciprocate in supporting one another. However, how reciprocal support among patients and informal caregivers in palliative care impacts on their decision making for care is not well understood.ObjectivesTo identify how reciprocal support among patients with advanced illness and their informal caregivers in specialist palliative care impacts on their decision making for care.MethodsBetween July 2021 and May 2022, 30 qualitative interviews were conducted with 14 patient and caregiver dyads, seven nondyad caregiver participants and one nondyad patient participant (total n = 36), recruited from a large regional specialist palliative care service. Data were analyzed using Corbin and Strauss grounded theory method.ResultsReciprocal support among patients and informal caregivers was underpinned by obligation and choice. Caregivers who felt obliged to care had difficulty communicating with the patient about the patient's preferences for care and their own wishes for patient care. Patients who felt obliged to accept support from their caregiver tended to minimize caregiver participation in decision making which made caregivers feel disempowered in discussions about patient care. Caregivers tended to be more involved in decision making when caregivers assumed caregiving duties by choice and when the patient did not feel restricted by their reliance on their caregiver. Open communication between patients and caregivers made patients more trusting of their caregiver.ConclusionPatient and caregiver dyadic interventions in specialist palliative care involving decision making need to account for how obligation and choice manifest and function between the patient and caregiver.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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