Predictors of caregiver burden across the home-based palliative care trajectory in Ontario, Canada

Family caregivers of patients enrolled in home-based palliative care programmes provide unpaid care and assistance with daily activities to terminally ill family members. Caregivers often experience caregiver burden, which is an important predictor of anxiety and depression that can extend into bereavement. We conducted a longitudinal, prospective cohort study to comprehensively assess modifiable and non-modifiable patient and caregiver factors that account for caregiver burden over the palliative care trajectory. Caregivers (n = 327) of patients with malignant neoplasm were recruited from two dedicated home-based palliative care programmes in Southern Ontario, Canada from 1 July 2010 to 31 August 2012. Data were obtained from bi-weekly telephone interviews with caregivers from study admission until death, and from palliative care programme and home-care agency databases. Information collected comprised patient and caregiver demographics, utilisation of privately and publicly financed resources, patient clinical status and caregiver burden. The average age of the caregivers was 59.0 years (SD: 13.2), and almost 70% were female. Caregiver burden increased over time in a non-linear fashion from study admission to patient death. Increased monthly unpaid care-giving time costs, monthly public personal support worker costs, emergency department visits and low patient functional status were associated with higher caregiver burden. Greater use of hospice care was associated with lower burden. Female caregivers tended to report more burden compared to men as death approached, and burden was higher when patients were male. Low patient functional status was the strongest predictor of burden. Understanding the influence of modifiable and non-modifiable factors on the experience of burden over the palliative trajectory is essential for the development and targeting of programmes and policies to support family caregivers and reduce burden. Supporting caregivers can have benefits such as improved caregiver health outcomes, and enhancing their ability to meet care-giving demands, thereby potentially allowing for longer patient care in the home setting.

From brown envelopes to community benefits: the co-option of planning gain agreements under deepening neoliberalism

The provision of physical and social infrastructure in the form of roads, green spaces and community facilities has traditionally been provided for by the state through the general taxation system. However, as the state has been transformed along more neoliberal lines, the private sector is increasingly relied upon to deliver public goods and services. Planning gain agreements have flourished within this context by offering another vehicle through which local facilities are privately funded. Whilst these agreements reflect the broader dynamics of neoliberalism, they are commonly viewed as a tool which can be employed to challenge these very dynamics by empowering local communities to secure more just planning outcomes. This paper counters such claims. Based on evidence gathered from 80 interviews with planners, councillors, developers and community groups in Ireland, the paper demonstrates how planning gain agreements have been strategically redeployed by the holders of political and economic power to serve their own ends. In seeking to understand why and how this has occurred, specific consideration is given to the changing power dynamics between the state and private capital under neoliberalism. The paper highlights how institutional arrangements have enabled developers to infiltrate the political sphere in more subtle and implicit ways than ever before. We conclude by arguing that planning gain must be understood as a mechanism which has been manipulated in ways which essentially work to preserve and enhance, rather than redress, existing power imbalances in the planning system by facilitating large scale transfers of wealth upwards in society.

Perceptions of the common good in planning

There has been plenty of debate in the academic literature about the nature of the common good or public interest in planning. There is a recognition that the idea is one that is extremely difficult to isolate in practical terms; nevertheless, scholars insist that the idea ‘…remains the pivot around which debates about the nature of planning and its purposes turn’ (Campbell & Marshall, 2002, 163–64). At the point of first principles, these debates have broached political theories of the state and even philosophies of science that inform critiques of rationality, social justice and power. In the planning arena specifically, much of the scholarship has tended to focus on theorising the move from a rational comprehensive planning system in the 1960s and 1970s, to one that is now dominated by deliberative democracy in the form of collaborative planning. In theoretical terms, this debate has been framed by a movement from what are perceived as objective and elitist notions of planning practice and decision-making to ones that are considered (by some) to be ‘inter-subjective’ and non-elitist. Yet despite significant conceptual debate, only a small number of empirical studies have tackled the issue by investigating notions of the common good from the perspective of planning practitioners. What do practitioners understand by the idea of the common good in planning? Do they actively consider it when making planning decisions? Do governance/institutional barriers exist to pursuing the common good in planning? In this paper, these sorts of questions are addressed using the case of Ireland. The methodology consists of a series of semi-structured qualitative interviews with 20 urban planners working across four planning authorities within the Greater Dublin Area, Ireland. The findings show that the most frequently cited definition of the common good is balancing different competing interests and avoiding/minimising the negative effects of development. The results show that practitioner views of the common good are far removed from the lofty ideals of planning theory and reflect the ideological shift of planners within an institution that has been heavily neoliberalised since the 1970s.