The type and amount of care provided by older adult caregivers to a spouse with cancer: Results from a mixed methods study

INTRODUCTION: Spouses of older adults with cancer provide most long-term informal care, and those receiving treatment for cancer rely on this care, but few studies have examined this in Eastern Europe. Therefore, this study aims to understand the type and amount of care provided by older adult caregivers to their spouses during active cancer treatment in Bulgaria, and how patient and caregiver sociodemographic and health variables influence the care provided. MATERIALS AND METHODS: This study used an exploratory mixed-methods convergent parallel research design comprising a cross-sectional survey (n = 90) and in-depth qualitative interviews (n = 13). Older adult caregivers (≥ 65 years) to a spouse receiving active cancer treatment were recruited from the USHATO Hospital, Sofia, Bulgaria from November 2024 to April 2025. The type and amount of care were measured using the National Study of Caregiving (NSOC) scales. Multivariable logistic regression models were used to assess the impact of sociodemographic factors (e.g., age, sex, number of comorbidities, education, income, duration of care in months, supports received, and patient cancer stage) on caregiving hours per week. Caregivers were purposively recruited from the survey sample, and face-to-face interviews were conducted. Open-ended interviews were analyzed using Braun and Clarke's method. The qualitative and quantitative results were integrated using a convergence joint display table. RESULTS: The mean age of caregivers was 70.3 (SD = 4.8) years and 70.6 (SD = 6.1) years for patients. Most caregivers were female (58.9%) and of Bulgarian ethnicity (96.7%). Patients had varied cancer and treatments but mostly advanced disease (62.2%). Over 80% of caregivers provided full-time caregiving in the past month, with a median of 8 h per day caregiving. Most caregivers primarily provided support with activities of daily living and instrumental activities of daily living. Caregivers with higher education (OR = 0.30, 95% CI 0.10-0.86) were less likely to provide more hours of caregiving. Themes included: caregivers providing around the clock care and personal and emotional support, not defining themselves by the role, and not asking for additional resources. DISCUSSION: Caregivers provided full-time care, mainly assisting with personal support, and caregivers with higher education were less likely to spend more time on caregiving.