Caregiver burden and health-related quality of life among family caregivers of oesophageal cancer patients: a prospective nationwide cohort study

Navigating life after gastric cancer surgery: a qualitative exploration of the dyadic patient-caregiver perspective on quality of life outcomes

INTRODUCTION

Gastric cancer (GC) families as a whole face the stressful time of cancer together, and the quality of life (QoL) of both the patient and the caregiver can be affected. Most past researchers have focused on the QoL of GC patients, but have neglected the role that caregivers play in the treatment process. The purpose of this study was to examine the factors influencing QoL of GC patients and their family caregivers, to compare the interactions and similarities and differences between the two influences, and to construct a conceptual model of the influences on QoL of GC patients and their caregivers based on the results of the study.

METHODS

This descriptive qualitative study was conducted in 2024 at two branches of a tertiary hospital in China, and participants were recruited by adopting a purposive sampling approach, where participants were patients with GC who met the criteria recommended by gastrointestinal surgeons and nurses, and caregivers were designated by patients. The sample was selected considering maximum differentiation, such as age, gender, cancer stage, and disease duration of the respondents. The sample size was based on data saturation with no new themes emerging. Based on the results of the pre-interviews, we made some adjustments to the interview format, i.e., interviewing some informants individually and others jointly. We used semi-structured interviews for data collection for the qualitative study, where participants were informed about the study, their roles, the risks and benefits of the study, and signed an informed consent form before the interviews began. In addition, the quality of field notes was assessed after each session. The process was the same for all interviews. To ensure the accuracy of the information, all information transmitted on paper was reviewed while listening to the recorded voice. We used directed content analysis to analyze the content of the interviews.

RESULTS

A total of 30 patients and 26 caregivers were interviewed. Four themes emerged from the study, which were contextual factors (disease-specific factors, physical and social environments and individual and family characteristics), knowledge and belief factors (self symptom assessment and healthcare seeking behavior, health information delivery and accessibility, life priority adjustment), self-regulation factors (strategies for health behavior change, role adaptation and emotion regulation) and social facilitators (positive motivation and emotional support from family, friends, and society, missing companionship and challenges encountered by family and friends visiting the patient after surgery, caregiving burdens and challenges). In addition, the study confirmed a high correlation between the QoL of patients and caregivers.

CONCLUSION

Our results address past gaps in the understanding of QoL for families with GC and update the concept of QoL by constructing a conceptual model of the factors that influence QoL for GC survivors and caregivers, as well as outlining the changes needed to improve health outcomes and QoL for survivors and their caregivers.

Is intrapersonal emotional competence a personal resource for the quality of life of informal caregivers of cancer patients unlike interpersonal emotional competence?

INTRODUCTION

This study assessed the influence of intrapersonal (one's own emotions) and interpersonal (emotions of others) emotional competence (EC) of informal caregivers on their quality of life (QoL) at the beginning of cancer care.

METHODS

Participants completed two questionnaires assessing their intrapersonal and interpersonal EC (S-PEC) as well as their QoL (SF-36) at the beginning of treatments. Multivariate ANCOVA regression analyses were then performed to explore the influence of EC on QoL.

RESULTS

The questionnaires were completed by 203 caregivers. As expected, intrapersonal EC was associated with a better QoL in all sub-dimensions (p < 0.01). More surprisingly, interpersonal EC was associated with worse QoL in terms of physical role (- 8.97 [95% CI - 16.74; - 1.19]), emotional role (- 8.37 [95% CI - 16.27; - 0.48]), and general health (- 4.50 [95% CI - 8.08; - 0.92]).

CONCLUSION

Intrapersonal EC should be improved for better QoL of caregivers of cancer patients. However, the more caregivers are attentive to the emotions of others (e.g., by identifying, understanding, listening and helping to manage emotions), the more their physical and psychological state has an impact on their daily life and their perceived health is impaired.

Resilience mediates the impact of caregiver burden on quality of life among informal caregivers of gastrointestinal cancer patients receiving adjuvant chemotherapy: A cross-sectional study

PURPOSE

The unclear relationships between caregiver burden, resilience, and quality of life among informal caregivers of patients with Gastrointestinal cancer receiving adjuvant chemotherapy prompted this study. The objective was to explore these relationships and investigate the mediating role of resilience.

METHODS

Between June 2022 and March 2023, totally 206 informal caregivers, who were responsible for patients undergoing postoperative chemotherapy for Gastrointestinal cancer in a public hospital, participated in this study. They completed standardized questionnaires assessing demographic information, caregiver burden, resilience, and quality of life. We performed structural equation modeling with Amos 26.0 to validate the hypothesized relationship between resilience, caregiver burden, and quality of life, and used the bootstrapping method to detect resilience's mediating effect.

RESULTS

Moderate caregiver burden existed for caregivers (42.11 ± 12.82), and caregivers reported lower quality of life, with physical health scores of 44.92 ± 10.61 and mental health scores of 45.62 ± 11.91. Moreover, caregiver burden exhibited a negative predictive relationship with mental health (rs = -0.329, P < 0.01), physical health (rs = -0.236, P < 0.01) and resilience (rs = -0.393, P < 0.01). The structural equation modeling showed that resilience acted as a crucial role in mediating the adverse impact of caregiver burden on mental health (β = -0.210, P < 0.001), and the tested model matches the data very well.

CONCLUSIONS

Regarding informal caregivers of patients undergoing chemotherapy for Gastrointestinal cancer, their caregiving burden negatively affects quality of life, while resilience partially mediates the impact of caregiving burden on mental health.

Exploring Factors Influencing Caregiver Burden: A Systematic Review of Family Caregivers of Older Adults with Chronic Illness in Local Communities

This study aimed to systematically review and analyze factors contributing to caregiver burden among family caregivers of older adults with chronic illnesses in local communities. Specific objectives included exploring the characteristics of older adults with chronic illness and caregiver burden through an extensive literature review and identifying factors influencing caregiver burden in this population. Using Korean (RISS, KISS, and KoreaMed) and international (EMBASE, MEDLINE, CINAHL, and the Cochrane Library) databases, this study employed systematic search methods to identify relevant literature. The inclusion and exclusion criteria were systematically applied in accordance with the PRISMA guidelines, focusing on studies that addressed caregiver burden among family caregivers of older adults with chronic illnesses in local communities. Following the database search, 15,962 articles were identified. After eliminating duplicates and applying the selection criteria, 18 studies were included in this review. These studies, representing various countries, contribute to a diverse dataset covering caregiver and care-recipient characteristics, including age, sex, chronic conditions, and various caregiver burden assessment tools. This systematic review provides a comprehensive understanding of the factors that influence caregiver burden among family caregivers of older adults with chronic illness in local communities. These findings emphasize the need for integrated nursing interventions and community efforts to address the welfare concerns of this population and support their caregivers.

Trajectory of Caregiver Burden and Associated Factors in Family Caregivers of Individuals with Colorectal Cancer: A Longitudinal, Observational Multicenter Study

Purpose

To (1) investigate the changes in 5 domains (lack of family support, impact on finance, impact on daily schedule, impact on health, and self-esteem) of family caregiver (FC) burden and overall burden for first diagnosed colorectal cancer; (2) exploring changes in FC burden for colorectal cancer patients over time and analyze the trajectory and sub-trajectories of FC burden; and (3) identify the FC-related and patient-related factors most associated with the overall FC burden and each of its sub-trajectories.

Patients and methods

This study is a descriptive longitudinal study. A convenience sampling method was used to recruit patients with colorectal cancer and their primary FCs from seven hospitals.

Results

A total of 185 pairs of first diagnosed colorectal cancer patient and their FC were investigated for 4 times. The results reveal the overall burden and 5 domains of burden showed a trend of increasing first and then decreasing, and the burden was the heaviest at the time in the middle of chemotherapy. In the course of time, the aspect that caused the greatest amount of burden on average transitioned from the "effect on daily schedule" (range= 3.3 and 3.9) to the "effect on finances" (range= 3.1 to 3.4).

Conclusion

Almost 88% of FCs have a either a moderate or a high level of burden. The quality of life of patients and the self-efficacy, social support and care ability of FCs have a great impact on the overall FC burden and each sub-trajectory.

Caregiver burden and health-related quality of life: A study of informal caregivers of older adults in Ghana

BACKGROUND

Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghana to date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among  informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship  between caregiver burden and HRQoL among informal caregivers of older adults in Ghana.

METHODS

We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50 years) in the Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was used to measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of  0.05 or less.

RESULTS

The mean age of the informal caregivers was 39.15 years and that of the care recipients was 75.08 years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (β = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants with no formal education (β = -1.204, SE= .4085, p value = 0.01), those with primary level of education (β = -2.390, SE= .5099, p value = 0.001) or junior high school education (β = -1.113, SE= .3903, p value= 0.01) had a significantly decreased HRQoL compared to those with tertiary level of education. Participants who were between the ages of 18-24 (β = 2.960, SE= .6306, p value=0.001), 25-34 (β = 1.728, SE= .5794, p value = 0.01) or 35-44 (β = 1.604, SE= .5764, p value= 0.01) years significantly had increased HRQoL compared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the past year before the survey significantly had increased HRQoL compared to those who utilized healthcare services five or more times in the past year (β = 4.786, SE=. 4610, p value= 0.001).

CONCLUSION

Consistent with our hypothesis, this study reported a significant negative association between caregiver burden and HRQoL. Our findings partially  support the conceptual model of HRQoL used in this study. We recommend that health and social policy measures to improve HRQoL among  informal caregivers of older adults should consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors.

The mediating effect of sense of coherence on the caregiver ability-caregiver burden relationship for caregivers of children with liver transplantation in China

BACKGROUND

Caregivers of children who have had liver transplantation often experience chronic care stress. Previous studies have focused on caregivers' negative feelings (e.g., caregiver burden), but few studies have focused on caregivers' positive feelings (e.g., sense of coherence) and caregiver ability.

OBJECTIVES

The study purpose was to investigate the status of the burden of caregivers of children with liver transplantation, and to explore the mediating role of sense of coherence between caregiver ability and caregiver burden.

METHODS

There were 461 questionnaires collected from a tertiary-level hospital from caregivers of children who had liver transplantation from April to June 2022. Demographic data, Family Caregiver Task Inventory, Sense of Coherence Scale-13, and Zarit Burden Interview were used. The STROBE checklist was monitored.

RESULTS

The average caregiver burden score was 32.19 ± 16.71. The distribution of caregiver burden levels was mild (42.52%), none (26.25%), moderate (24.95%), and severe (6.29%). Caregiver ability score was negatively correlated with caregiver burden score; however, sense of coherence score was negatively correlated with caregiver burden score. Caregiver ability partially mediated caregiver burden through sense of coherence (38.51%).

CONCLUSION

The caregiver burden level was not heavy in general. Both positive and negative feelings were present in caregivers. Caregiver ability also reduced the caregiver burden through sense of coherence.

Caregiver burden among family caregivers of patients with advanced cancer in a palliative context: A mixed-method study

AIM

To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context.

DESIGN

A sequential, explanatory, mixed-method study was performed.

METHODS

Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third-level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor-Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi-structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann-Whitney U test, Kruskal-Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following-a-thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden.

RESULTS

The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta-themes and nine meta-subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID-19 and spousal relationship with patients) and factors that mitigate burden (social support).

CONCLUSION

Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family-centred palliative care must be further developed.

IMPLICATIONS FOR THE PROFESSION

It is important to develop family-centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture-oriented death education in palliative units.

IMPACT

This study adopted a mixed-method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context. Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent. The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family-centred care in Chinese palliative units.

REPORTING METHOD

The results of this study are reported based on the guidelines of the Mixed-Methods Article Reporting Standards.

PATIENT OR PUBLIC CONTRIBUTION

Eligible caregivers were invited to participate in the study and semi-structured interviews. Nurse managers of the palliative unit helped us access the patient-management system.

Caregivers' perception of patients' interpersonal and psychiatric alterations: What is the impact on their health?

PURPOSE

Previous research conducted among caregivers of patients with cancer revealed a poor Quality of Life (QoL) and high levels of distress. In addition to the influence of patients' clinical state, caregivers' appraisals of patients' difficulties should be considered as another predictor of poor caregiver health. This study aims to test the association between caregivers' health (i.e., QoL, depression and anxiety) and their perception of patients' difficulties.

METHODS

199 caregivers of patients with cancer completed an online survey based on questionnaires measuring their QoL, depression and anxiety, as well as their perception of patients' cognitive, emotional, functional, psychiatric and interpersonal difficulties.

RESULTS

It was found that the appraisal of patients' impairments in all domains was mainly correlated with poor caregivers' QoL (Pearson correlations ranged from 0.14 to 0.45; p ≤ .05). Furthermore, linear regression analyses showed that, after controlling for age, sex education level, professional activity and living with or without the patient, the appraisal of patients' interpersonal abilities (β = 0.25, p ≤ .05), psychiatric difficulties (β = -0.25, p ≤ .01) and living with the patient were the main predictors of caregivers' QoL.

CONCLUSION

This study highlights the importance of better understanding the role of patients' social and psychiatric difficulties when examining caregivers' health. This indicates the importance of providing support and offering information to caregivers to alert them to the role of patients' social and psychiatric difficulties on their own health. Future studies should better understand how these difficulties are associated with caregivers' perception of identity/sociability alterations in patients and how caregivers cope with these changes.

Perceived burden and need for support among caregivers of cancer patients

BACKGROUND

The aims of this study were to examine (1) the perceived burden among caregivers and identify those in risk of high burden and (2) the need for support among caregivers and identify associated factors.

MATERIALS AND METHODS

Cancer patients who participated in an educational program at the Montebello Center (MBC) in Norway between May 2021 and February 2022 were asked to invite a caregiver to answer a questionnaire. The caregiving burden was assessed with the Caregivers Reaction Assessment (CRA) that consists of 24 questions scored from 1 (strongly disagree) to 5 (strongly agree), covering five domains. A mean sum score was calculated for each domain. Higher subscale scores indicate higher levels of burden, except for caregiver esteem where a high score indicates a low burden. Need for support was assessed with 13 questions.

RESULTS

Of 464 invitations, 185 caregivers responded (response 40%), median age was 58.0 years and 58% were male. Caregiver burden mean scores were: 2.6 (SD 1.03) for Impact on schedule, 2.1 (SD 0.79) for Lack of family support, 2.1 (SD 0.76) for Impact on health, 2.0 (SD 0.86) for Impact on finances, and 4.2 (SD 0.47) for Caregiver esteem. Female caregivers, younger, higher education, having comorbidities, caring for patients having recurrence of cancer, and shorter time since diagnosis were associated with higher burden measured on individual subscales of the CRA. Most reported needs were information about: cancer, late effects and rehabilitation services and support from peers and professionals to cope with the new situation. Younger, caregiver comorbidity and recurrence of cancer of the patient were associated with more needs.

CONCLUSIONS

The results indicate that caregivers of cancer patients participating at the MBC report moderate caregiver burden, however, numerous caregivers reported need for support within several areas. Our findings need to be confirmed in a larger unselected group.

Associations in health-related quality of life between patients and family caregivers 1 year after oesophageal cancer surgery

PURPOSE

Whether patients' health-related quality of life (HRQL) influences the HRQL of their family caregivers remains to be clarified. Therefore, the aim of this study was to investigate the association in HRQL between patients and family caregivers one year after oesophageal cancer surgery.

METHODS

The study was based on a prospective, nationwide, and population-based cohort including patients treated by surgery for oesophageal cancer in Sweden from 2013 to 2021 and their family caregivers. Data were collected one year after surgery, using the summary score of the EORTC QLQ-C30 and the RAND-36 questionnaire. Univariate and multivariate linear regression models providing regression coefficients with confidence intervals (CI) were used to estimate the association between the HRQL among patients and family caregivers. The analyses were adjusted for potential covariates.

RESULTS

In total, 275 patients and paired family caregivers were included in the study. Patients reported a mean HRQL summary score of 81.4, indicating reductions in functions as well as many burdensome symptoms. Among family caregivers, lowest HRQL scores were reported for pain (69.2 ± 26.0) and energy/fatigue (65.1 ± 20.4). A 10-point change in the patients' summary score corresponded to a 7-point change for family caregivers' emotional role function (β = 7.0; 95% CI: 3.6-10.3). For other HRQL dimensions among the family caregivers, no clinically relevant associations with patients HRQL were found.

CONCLUSION

The current study indicates that family caregivers' emotional role function is influenced by patients' overall HRQL one year after surgery. The finding suggests that follow-up interventions should include not only patients but also their family caregivers.