Predictors of burden and quality of sleep among family caregivers of patients with cancer

Caregivers of patients with cancer: perceived stress, quality of life and immune function

OBJECTIVES

To examine the mediating effect of quality of life (QoL) on the relationship between perceived stress and immune function in Korean family caregivers of patients with cancer.

METHODS

In this cross-sectional study, 89 family caregivers of patients with cancer completed perceived stress and QoL questionnaires. Immune function was assessed using two proinflammatory biomarkers, IL-6 and tumour necrosis factor-alpha (TNF-α). Multiple parallel mediator regression was conducted using four mediators (burden, lifestyle disruption, positive adaptation and financial concern) representing the subscales of QoL related to caregiving.

RESULTS

Psychological (indirect effect (ab)=-0.52, 95% CI -1.25 to -0.01) and physical (ab=-0.44, 95% CI -1.07 to -0.05) stress had a significant indirect effect on IL-6 levels attributed to lifestyle disruption associated with caregiving. Psychological (ab=-0.97, 95% CI -2.37 to -0.11) and physical (ab=-1.10, 95% CI -2.87 to -0.08) stress also had a significant indirect effect on TNF-α as a result of financial concerns owing to caregiving. Other indirect effects of psychological/physical stress on inflammation were not significant.

CONCLUSION

This study demonstrated that the effects of perceived psychological and physical stress on IL-6 and TNF-α levels were mediated by the caregiver's QoL, especially lifestyle disruption and financial concerns. Stress management and improvement of caregivers' QoL related to lifestyle disruption and financial issues should be considered to reduce the negative effects of caregiving on immune function.

Examination of the relationship between the empathic tendencies and sleep quality of caregivers of cancer patients

PURPOSE

The present study aims to reveal the relationship between the empathic tendencies and sleep quality of caregivers of cancer patients.

MATERIAL AND METHOD

This cross-sectional study was conducted with caregivers of cancer patients registered in the oncology unit of a hospital between May and July 2024 (n = 346). The study data were collected using a sociodemographic information form, the Empathic Tendency Scale, and the Pittsburgh Sleep Quality Index. The data were analyzed using the Pearson correlation and hierarchical regression analyses as well as descriptive statistics.

FINDINGS

59.5% of the participants were female and 88.2% lived with patients. 62.7% of the cancer patients were male and 61.1% were partially dependent in daily life activities. The caregivers had a mean total score of 70.58 ± 16.85 on the Empathic Tendency Scale and a mean total score of 4.40 ± 3.94 on the Pittsburgh Sleep Quality Index. It was found that there was a negative, strong, and statistically significant relationship between the mean total scores on the Empathic Tendency Scale and the Pittsburgh Sleep Quality Index (r = - 0.924; p < 0.001). According to the hierarchical regression model, certain sociodemographic features of the caregivers explained the variance in empathic tendency (Adj. R2 = 0.607; p < 0.001), whereas when sleep quality components were added to the model, the variance in empathic tendency was explained (Adj. R2 = 0.896; p < 0.001).

CONCLUSION

The caregivers of cancer patients were found to have high empathic tendencies, which was associated with high sleep quality. Furthermore, low empathic tendencies among the caregivers were found to be primarily associated with increasing length of care and advancing patient age. The findings underscore the pivotal role that empathic approaches play in enhancing the quality of care, underscoring the necessity for augmented interventions that prioritize a compassionate approach, and the management of empathy in caregivers of cancer patients.

Family caregiver related factors contributing to role strain among adult patients with cancer at a National Referral Hospital in Kenya: cross-sectional study

Introduction

cancer care involves a long-term treatment plan with a demand for continuous care which currently is largely being offered as an outpatient service and worldwide family caregiving is becoming the backbone for long-term care delivery. There is a paucity of information regarding family caregivers of patients with cancer in Africa. Therefore, this study aimed to determine family caregiver-related factors contributing to role strain among family caregivers of adult patients with cancer, this being a first step in designing the best strategies to mitigate the role strain.

Methods

the study adopted an analytical cross-sectional design involving 255 systematically sampled family caregivers of adult patients attending Kenyatta National Hospital outpatient cancer treatment clinic between February and March 2020. Both quantitative and qualitative data were collected. Quantitative data from a structured questionnaire and Modified Caregiver Strain Index (MCSI) tool was analyzed by deriving descriptive statistics and ordinal logistic regression was performed to derive the relationship between the independent variables and the dependent variable. Quantitative data was presented by use of tables and charts. SPSS software version 25 was utilized in data analysis. Qualitative data from focused group discussion interviews was analyzed thematically.

Results

from the study findings, the family caregiver-related factors associated with role strain include being married (AOR=0.49, 95% CI 0.252-0.960, p=0.038); unemployed (AOR=3.29, 95% CI 1.833-5.894, p=0.001); providing care for <5 hours (AOR 0.40, 95% CI 0.227-0.715, p=0.002); lack of perception of strain related to social isolation (AOR=0.20, 95% CI 0.075-0.541, p=0.001), disturbed sleep cycle (AOR=0.30, 95% CI 0.141-0.641, p=0.002), social support (AOR=0.13, 95% CI 0.051-0.391, p=0.001) and costly transport costs (AOR=0.32, 95% CI 0.121-0.816, p=0.017).

Conclusion

there are various family caregiver-related factors associated with the role strain. This therefore calls for healthcare practitioners to pro-actively consider FCGs for psychological counseling, social support groups, health education, and provision of literature materials on self-care and self-financial empowerment, spiritual support and referral for financial support if available.

The Effect of Benson's Relaxation Technique on Coping Strategies Among Informal Caregivers of Cancer Patients: A Randomized Controlled Trial Study

BACKGROUND

Informal caregivers of cancer patients often experience high levels of stress and burden, leading to the adoption of ineffective coping strategies. This can result in psychological problems for the caregivers and inadequate care provision.

OBJECTIVE

This study aimed to investigate the impact of Benson's relaxation technique (BRT) on coping strategies among informal caregivers of cancer patients.

INTERVENTIONS/METHODS

This open-label randomized clinical trial enrolled 113 caregivers visiting the radiotherapy and chemotherapy departments of Vasei Hospital in Sabzevar, Iran, who scored ≥48 on the Novak and Guest Caregiver Burden Inventory. The participants were randomly allocated to either the intervention group or the control group. The intervention group received BRT, with participants performing the technique twice a day for 20 minutes each time over a 1-month period. The control group did not receive any intervention. Coping strategies were assessed using Endler and Parker's coping strategies inventory.

RESULTS

The findings of the study revealed that the intervention group showed an increase in the utilization of problem-oriented coping strategies (P = .076) and a decrease in the utilization of emotion-oriented coping strategies (P < .001) and avoidance-oriented coping strategies in the intervention group compared with the control group (P = .004).

CONCLUSIONS

Findings suggest that BRT, as a cost-effective and nonpharmacological intervention, effectively reduces the reliance on emotion-oriented and avoidance-oriented coping strategies among informal caregivers of cancer patients.

IMPLICATIONS FOR PRACTICE

Healthcare professionals working in oncology settings are encouraged to incorporate BRT into their care practices.

Sleep quality, caregiver burden, and individual resilience among parents of children with epilepsy

PURPOSE

Parents caring for children with epilepsy have poor sleep quality and experience a certain level of caregiving burden. Individual resilience is a crucial psychological variable that contributes to health during extraordinary challenges. This study aimed to determine the relationships among individual resilience, caregiver burden, and sleep quality.

METHODS

This was a descriptive cross-sectional study with a convenience sample, following the STROBE guidelines. One hundred and ninety-one parents of children with epilepsy were invited to participate in the study. Of these, 173 participants completed measures of sleep quality, caregiver burden, and individual resilience. Path analysis was performed to probe the indirect relationship between individual resilience and sleep quality via caregiver burden.

RESULTS

Correlation analysis revealed that individual resilience total scores were significantly and marginally negatively correlated with caregiver burden and sleep quality total scores (r = -0.215, P <.01; r = -0.250, P <.01). Moreover, there was a significant moderate positive correlation between the total caregiver burden scores and total sleep quality scores (r = 0.389, P <.001). The path model showed that individual resilience is indirectly associated with sleep quality via caregiver burden.

CONCLUSION

The higher the level of individual resilience, the less the caregiver burden and the better the sleep quality for parents of children with epilepsy.

Sleep quality, anxiety and depression in advanced lung cancer: patients and caregivers

OBJECTIVE

To investigate the clinical implications of sleep quality, anxiety and depression in patients with advanced lung cancer (LC) and their family caregivers (FCs).

METHODS

A total of 98 patients with advanced LC and their FCs (n=98) were recruited from the Oncology Department in Nanfang Hospital. The Pittsburgh Sleep Quality Index (PSQI), consisting of seven components that evaluate subjective sleep quality, sleep latency, duration of sleep, sleep efficiency, sleep disturbances, sleep medication usage and daytime dysfunction, was used to assess sleep quality. Using the tool of Zung Self-rating Anxiety Scale (SAS) and Zung Self-rating Depression Scale (SDS), we tested the patients' status of anxiety and depression, respectively.

RESULTS

The prevalences of poor sleep quality, anxiety and depression in patients were 56.1%, 48.9% and 56.1%, respectively, while those in FCs were 16.3%, 32.6% and 25.5%, respectively. Patients had higher PSQI, SAS and SDS scores than did FCs (p<0.05). Significant correlations were found between the patients' and FCs' scores of PSQI/SAS/SDS (p<0.05). Multivariate Cox regression analyses indicated that sleep disturbances in patients (HR 0.413, 95% CI 0.21 to 0.80, p=0.01) and the global PSQI score of FCs (HR 0.31, 95% CI 0.14 to 0.71, p=0.00) were independent risk factors for patients' first-line progression-free survival (PFS). Moreover, patients' sleep latency (HR 2.329, 95% CI 1.36 to 3.96, p=0.00) and epidermal growth factor receptor mutations (HR 1.953, 95% CI 1.12 to 3.38, p=0.01) were significant prognostic factors for their overall survival (OS).

CONCLUSIONS

We demonstrated that presence of sleep disturbances in patients with advanced LC and the global PSQI Score of their FCs may be risk predictors for patients' poor first-line PFS. Patients' sleep latency was a potential risk factor for their OS.

Relationships between caregiving stress and sleep quality among family caregivers of older adults with dementia in Thailand

Background

Providing care for older people with memory loss is a significantly stressful task. The caregiver experienced deterioration of the care recipients regarding their cognitive and functioning abilities, often resulting in the caregiver's feelings of distress, stress, and unsatisfactory sleep quality.

Objective

This cross-sectional study aimed to examine the relationships between caregiving stress and sleep quality among family caregivers of older adults with dementia.

Methods

A simple random sampling method was used to recruit participants of seventy-two family caregivers who received care from a community long-term care facility at two primary hospitals in Thailand. Research instruments included the Relative Stress Scale and the Pittsburgh Sleep Quality Index. The data were analyzed using descriptive statistics, means, standard deviation, and simple linear regression.

Results

The study revealed that caregivers had a high level of caregiving stress (M = 49.68, SD = 4.71), and poor sleep quality (M = 12.44, SD = 3.60). Caregiving stress was positively correlated with poor sleep quality (r = 0.54, p < 0.01) with a large relationship.

Conclusion

Thai family caregivers of people with dementia reported high stress level and had poor sleep quality. The findings suggest that nurses in primary health care should focus on assessing stress levels and sleep quality as well as improving sleep quality for family caregivers by developing interventions.

Clinical Trial on Mindfulness with Family Caregivers for Patients with Cancer

To examine the effectiveness of a brief mindfulness-based interventions (MBIs) and educational interventions (EI) on self-efficacy and burden among family caregivers (FCs) of patients with cancer in Jordan. A quasi-experimental design was conducted. Two interventions were performed: the brief MBIs and the EIs were applied. A sampling of 138 FCs completed the study interventions. The FCs in the mindfulness group demonstrated a significant improvement in measures of self-efficacy and reduction in burden scores. Furthermore, in the EI group, only self-efficacy was significantly higher in the post-test. Burden reduction was significantly higher in the EI group than the mindfulness group. Appropriate supportive interventions should be directed to improve self-efficacy and reduce burden to assist FCs to carry out their crucial role in providing care for their patients.

How does beginning or ceasing of informal caregiving of individuals in poor health influence sleep quality? Findings from a nationally representative longitudinal study

BACKGROUND

Various cross-sectional studies exist examining the association between informal caregiving and sleep quality. However, there is a lack of longitudinal studies investigating whether beginning and ceasing of informal caregiving is associated with changes in sleep quality.

AIMS

Investigating whether beginning and ceasing of informal caregiving of individuals in poor health is associated with changes in sleep quality in both sexes.

METHODS

Data were taken from a nationally representative sample of individuals ≥ 40 years in Germany from 2008 to 2017. In our analytical sample, n equaled 22,910 observations. Based on the Pittsburgh Sleep Quality Index, the sleep quality was assessed by the difficulties falling asleep during the last month, difficulties with sleep because of waking up during the last month (in both cases: (from 1 = not during the last month to 4 = three or more times a week) and the overall assessment of sleep quality during the last month (from 1 = very good to 4 = very bad).

RESULTS

Asymmetric fixed effects regressions showed that in men beginning to provide informal care was associated with decreased overall sleep quality (β=-.09 (95% CI: -.15 - -.03), p<.01) and an increased likelihood of difficulties because of waking up (OR: 1.54 (95% CI: 1.07-2.20), p<.05), whereas ceasing to provide informal care was not associated with the outcome measures (both, in women and in men).

DISCUSSION

Starting informal caregiving had deleterious effects on sleep quality in men.

CONCLUSIONS

Efforts to assist men in maintaining sleep quality may be beneficial.

Caregiver burden and influencing factors among family caregivers of patients with glioma: A cross-sectional survey

OBJECTIVE

The main responsibility of caring for patients with glioma is assumed by family caregivers who experience a considerable burden during the care process. This study aimed to investigate the level of caregiver burden and explore its associated factors among family caregivers of patients with glioma.

METHODS

We conducted a cross-sectional study among 131 family caregivers of glioma patients from October 2017 to November 2019. We used the following measurement tools: a demographic questionnaire, the Zarit Burden interview (ZBI), the Hamilton anxiety and depression scale, and the family APGAR index. We used multiple linear regression analysis to determine the factors related to caregiver burden.

RESULTS

The ZBI score for the family caregivers of glioma patients was 31.29 (SD = 13.54), and most caregivers (71.7%) reported moderate and severe caregiver burdens. Caregivers' daily sleep time and anxiety symptoms and patients' depressive symptoms independently predicted caregiver burden.

CONCLUSIONS

Family caregivers of glioma patients experienced a moderate burden. Personalised psychological intervention and sleep health guidance for patients and caregivers should be considered to reduce family caregiver burden and enhance the quality of life and mental health of both patients and their caregivers.

Self-Management Coaching: Promoting Postoperative Recovery and Caregiving Preparedness for Patients With Lung Cancer and Their Family Caregivers

BACKGROUND

Quality of life (QOL) for patients undergoing lung resection and their family caregivers (FCGs) is often affected by surgical treatment for lung cancer.

OBJECTIVES

Patients and FCGs have a great deal of distress that affects their QOL. Introducing self-management skills soon after diagnosis improves patient and FCG outcomes.

METHODS

This article presents a intervention model for providing patients and FCGs with self-management skills. Patients and FCGs will learn how to identify and overcome challenges, set goals, and address unmet needs throughout the phases of surgery. The model and case examples are presented.

FINDINGS

Patients and FCGs gained self-efficacy. They were able to identify potential stressors that would otherwise become burdensome. Patients remained in control of their preoperative care and recovery, resulting in continued independence. FCGs achieved healthier well-being, which increased positive caregiving experiences.

Predictors of sleep disturbances in caregivers of patients with advanced cancer receiving home palliative care: A descriptive cross-sectional study

PURPOSE

To evaluate the quality of sleep in caregivers of patients with advanced cancer receiving home palliative care, basing the analysis on subjective and objective measures, and to develop a predictive model of sleep disturbances among this population.

METHOD

A descriptive cross-sectional study was conducted in six clinical management units within primary healthcare centres. Data were obtained during a period of six months, from a sample population of 41 caregivers. The Pittsburgh Sleep Quality Index (PSQI) and a 7-day accelerometry evaluation were performed to assess sleep quality. Daytime sleepiness, caregiver strain and quality of life were also evaluated.

RESULTS

According to the PSQI, 90.2% of participants had poor sleep quality. The average duration of night-time sleep, measured by accelerometry and the PSQI, was 6 h. Taking PSQI as the dependent variable, the study model predicted 40.7% of the variability (p < 0.01). The variables "Caregiver strain" and "Daily hours dedicated to care" produced the following results: B coefficient 0.645; p = 0.001; and B coefficient 0.230; p = 0.010, respectively.

CONCLUSIONS

The caregivers presented significant health-related alterations, including sleep disturbances, which were directly related to two variables: the index of caregiver strain and the number of hours per day dedicated to providing care.

COPD at the end of life: Predictors of the emotional distress of patients and their family caregivers

BACKGROUND

Few studies have focused on patients' emotional distress with end-stage chronic obstructive pulmonary disease (COPD) and their main family caregivers.

METHODS

Cross-sectional data about emotional, functional, and burden-related variables were collected from 85 patients with end-stage COPD and their 85 respective main family caregivers to determine the variables that could predict their emotional well-being. Descriptive analyses, comparison of means, hierarchical regression models, and comparative quali-quantitative analyses were carried out.

RESULTS

Data show that the great majority of patients with COPD spend years with this diagnosis, and have been admitted to the hospital several times in advance stage of illness the previous year of the moment of end-of-life stage. Furthermore, only a tiny percentage of the patients were functionally independent in the advanced stage of illness.

CONCLUSIONS

The emotional distress and the burden of the family caregiver play an essential role in the distress of the patient, in conjunction with the patient's own functional independence and the time living with the disease, and comorbidity. On the other hand, variables of the patient, such as time since diagnosis, number of hospital admissions, comorbidity, functional dependence, and emotional distress, play an important role in the family caregiver's emotional distress and burden. Understanding how these variables are related is key to designing appropriate programs to reduce the emotional distress the patients with COPD at the end of life and their family caregivers.

Effectiveness of Self-administered Acupressure for Family Caregivers of Advanced Cancer Patients With Insomnia: A Randomized Controlled Trial

BACKGROUND

Sleep disturbances are common among family caregivers (FCs) of patients with advanced cancer. Self-administered acupressure can combat insomnia, but no study has been conducted to evaluate its efficacy in caregivers of patients with advanced cancer.

OBJECTIVE

The aim of this study is to investigate whether self-administered acupressure improves sleep quality for FCs of patients with advanced cancer.

METHODS

Family caregivers of patients with advanced cancer who reported sleep disturbance (Pittsburgh Sleep Quality Index scores >5 in recent months) were recruited. The experimental group self-administered acupressure at the Baihui (GV20), Fengchi (GB20), Neiguan (PC6), and Shenmen (HT7) points over a 12-week period, whereas the comparison group received sleep hygiene education. Sleep quality was assessed subjectively at 4, 8, and 12 weeks after the intervention using the Pittsburgh Sleep Quality Index and objectively using actigraphy measurements. Improvements in sleep quality were analyzed using a generalized estimating equation.

RESULTS

Compared with the control group, the experimental group demonstrated significantly lower sleep latency (Wald χ2 = 11.49, P = .001) and significantly better sleep efficiency (Wald χ2 = 5.24, P = .02) according to actigraphy measurements, but Pittsburgh Sleep Quality Index scores did not differ significantly between the groups.

CONCLUSIONS

Self-administered acupressure did not demonstrate favorable effects on subjective sleep quality, but did reduce sleep latency and improve sleep efficiency, according to actigraphy measurements. Self-administered acupressure may help relaxation and sedation and promote sleep in FCs.

IMPLICATIONS FOR PRACTICE

Healthcare providers may consider advising FCs to apply this self-administered acupressure to improve their sleep latency and sleep efficiency.