Psychological Inflexibility in Primary Caregivers of Patients at the End of Life

Abstract

Objectives: The burden experienced by informal caregivers of patients at the end of life is a growing concern in palliative care. This study aimed to evaluate the relationship between caregiver burden and psychological inflexibility in primary caregivers of patients receiving home-based palliative care in the CSSV PADES service (Barcelona). Methods: A cross-sectional observational study was conducted between February 2023 and February 2024 with 35 primary caregivers. Psychological inflexibility was assessed using the AAQ-II and CFQ, depressive symptoms with the PHQ-9, caregiver burden with the Zarit scale, patient dependency with the Barthel Index, emotional distress with DME, and symptom intensity with EDM. Descriptive statistics and Spearman correlations were performed. Results: Psychological inflexibility and cognitive fusion were significantly correlated with depressive symptoms (PHQ-9) and showed positive associations with caregiver burden (Zarit). No significant association was found between caregiver burden and patient emotional distress (DME). Higher psychological inflexibility was associated with greater perceived caregiver burden. Conclusions: Findings highlight the protective role of psychological flexibility in informal caregivers in palliative contexts. Interventions based on Acceptance and Commitment Therapy (ACT) may help reduce emotional and physical burden. Future research should include longitudinal designs and larger samples to confirm causality and evaluate intervention effects.