Holding it all together: Family caregivers' support needs after very early supported discharge post stroke.

Family caregivers felt unprepared and overwhelmed after the VESD intervention ended due to its limited duration.

• Twelve family caregivers of persons who had received VESD after stroke were interviewed.
• In-depth, individual, semi-structured interviews were conducted.
• The VESD intervention provided important initial support but its limited duration left caregivers 'feeling unprepared, anxious, and overwhelmed by their new responsibilities.'
• Data were analysed using thematic analysis with an inductive approach.

Family caregivers experienced emotional strain alongside new and unclear caregiving demands following VESD.

• Overarching themes indicated that caregivers faced emotional strain alongside new and unclear demands.
• Caregivers struggled to balance caregiving with work and family life.
• Caregivers also coped with relationship changes following stroke.
• The study used a qualitative design to 'capture the caregivers' rich experiences and to allow themes to emerge directly from the data.'

Family caregivers perceived their role as informal medical coordinators and advocates within the healthcare system as particularly challenging.

• Caregivers described acting as informal medical coordinators and advocates for the person with stroke within the healthcare system.
• This role was identified as 'particularly challenging' by participants.
• The absence of structured follow-ups and professional guidance further intensified these challenges.
• The absence of caregiver-focused support also contributed to the difficulties experienced.

The absence of structured follow-ups, professional guidance, and caregiver-focused support intensified caregivers' challenges after VESD.

• No structured follow-up was available to caregivers once the VESD intervention ended.
• Lack of professional guidance was identified as a factor intensifying caregiver challenges.
• Caregiver-focused support was notably absent in the post-VESD period.
• These gaps collectively contributed to caregiver burden and unpreparedness.

Integration of caregivers into rehabilitation and provision of education and mental health support are essential for caregiver preparedness and well-being.

• The study underscores the need for 'sustained and comprehensive long-term strategies that include education and mental health support for caregivers in the rehabilitation process after stroke.'
• Integration of caregivers into rehabilitation was identified as 'essential to ensure their preparedness and well-being.'
• Such measures were described as 'crucial not only for reducing caregiver burden, but also for promoting better long-term outcomes for both caregivers and the person with stroke.'
• The study was conducted in Sweden in the context of the VESD model.