Objective/Purpose: Despite high levels of distress, cancer carers often demonstrate low engagement with psychological support services and interventions. Understanding the modifiable factors influencing uptake of psychological support is essential in informing the delivery of carer services and the development of carer interventions. We aimed to develop a conceptual model to explain the attitudinal barriers to psychological service use among carers.
Procedures: To ensure the model was empirically grounded, we systematically searched PsycINFO, MEDLINE, CINAHL and EMBASE for qualitative peer-reviewed articles reporting on adult carers of people with a chronic illness (including cancer) seeking psychological support for themselves. Articles were reviewed for eligibility, relevant data extracted, and quality appraisal conducted. An inductive qualitative meta-synthesis and thematic analysis was conducted and interrelationships between themes and subthemes distilled into a conceptual model.
Results: Of 10,196 articles screened, 31 were included for meta-synthesis and model development. Most studies (58%, n=18) reported on cancer carer populations. The model proposes that carers commonly hold pre-existing, often stigmatised or erroneous beliefs about mental health, the value and role of psychological services for carers and the validity of accessing support for themselves. These beliefs are further shaped and reinforced in patient-centric healthcare systems where there is limited carer-tailored support and a perceived lack of acknowledgement of carer needs from healthcare professionals. Together, negative mental health beliefs and the invisibility of carer needs in the health system strengthen perceptions that seeking psychological support is contradictory to cultural expectations of carer stoicism and self-sacrifice.
Conclusions and Clinical Implications: Our model suggests, at a systems level, we need to increase access to carer-specific support and train HCPs to recognise and be sensitive to carer needs. At an individual carer level, increasing mental health literacy and self-compassion is critical in reducing stigma and detrimental carer role perceptions.