The Mediating Effect of Depression on the Relationship between Social Support, Spirituality and Burnout in Family Members of Patients with Cancer

Social Support, Depression and Anxiety in Cancer Patient-Relative Dyads in Early Survivorship: An Actor-Partner Interdependence Modeling Approach

OBJECTIVE

Cancer places a psychological burden on both patients and their relatives. Perceived social support influences the extent of psychological distress. Our aim was to investigate associations between positive support, detrimental interactions, depression and anxiety in patient-relative dyads in the initial period after diagnosis.

METHODS

Patients with a solid tumor and their relatives participated in this prospective, multicenter observational study. Participants answered validated measures including the Illness-specific Social Support Scale (SSUK-8), the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder Scale (GAD-7). We analyzed cross-sectional data from the initial time following diagnosis with paired t-tests and actor-partner interdependence models.

RESULTS

A total of 347 dyads of patients (mean age 59.9 years) and their relatives (mean age 56.7 years) participated. Compared to their relatives, patients reported significantly higher levels of depression (patients: M = 6.31, SD = 4.94; relatives: M = 5.44, SD = 4.77) and lower levels of anxiety (patients: M = 4.40, SD = 4.10; relatives: M = 4.98, SD = 4.47) as well as more positive support (patients: M = 14.31, SD = 2.07; relatives: M = 12.46, SD = 3.29) and a lower frequency of detrimental interactions (patients: M = 3.21, SD = 2.97; relatives: M = 3.66, SD = 2.93). Intrapersonal effects: Positive support was associated with lower distress only for relatives, whereas detrimental interactions were associated with higher distress for both patients and relatives (all p < 0.05). Interpersonal effects: More positive support and fewer detrimental interactions experienced by relatives were associated with lower patient distress (all p < 0.05).

CONCLUSIONS

Better support for relatives may not only reduce their own distress, but also patients' distress. Relatives experience similar levels of distress and poorer social support than patients.

Self-efficacy as mediators of the association between dyadic coping and quality of life among spousal caregiver of patients with cervical cancer

Objective

This study aims to explore the influence of dyadic coping (DC) on the quality of life (QoL) of spousal caregivers for patients with cervical cancer and to investigate the mediating role of self-efficacy in this relationship.

Methods

A convenience sample of 206 spouses of cervical cancer patients from five hospitals in Jiangsu Province, China, was included in the study. The participants completed three instruments: the 12-item Short-Form Health Survey, the General Self-Efficacy Scale, and the Dyadic Coping Inventory. Structural Equation Modeling (SEM) was used to analyze the mediating effect of self-efficacy in the DC and QoL relationship.

Results

The study found a positive correlation between self-efficacy and DC. Self-efficacy partially mediated the impact of DC on QoL, accounting for 16% of the total effect. Self-efficacy played a mediating role in facilitating the indirect positive effects of DC on QoL.

Conclusions

Spousal caregivers of cervical cancer patients frequently experience a relatively low QoL. The results suggest that interventions aimed at enhancing DC among spousal caregivers should incorporate strategies to improve self-efficacy, given its mediating role in the positive relationship between DC and QoL.

Improving Sexual and Gender Minority Cancer Care: Patient and Caregiver Perspectives From a Multi-Methods Pilot Study

Purpose

Up to 1 million lesbian, gay, bisexual, and transgender (i.e., sexual and gender minority, SGM) individuals in the United States have histories of cancer. This medically underserved population is diverse, with complex sexualities and gender identities, and distinct health concerns. SGM persons experience disproportionate risks for, and rates of, anal, breast, cervical, colorectal, endometrial, lung, and prostate cancers, in addition to cancers affecting transgender persons who have undergone sex-reassignment. SGM individuals are linked by shared experiences of stigmatization as a minority population for which little cancer research has been conducted. SGM cancer patients frequently report reluctance to seek healthcare, have poorer outcomes following diagnosis, engage in elevated risk behaviors (i.e. smoking and alcohol use) even after cancer diagnosis, have difficulty making emotional adjustment to illness, and experience higher rates of psychological distress. They report less satisfaction with cancer care, deficiencies in patient-centeredness and shared decision-making, gaps in care, and social isolation. Minority stress resulting from experiences of anti-SGM sentiment and discrimination affects cancer patients and their informal cancer caregivers. Our paper presents findings from a pilot study to identify gaps and opportunities to improve cancer care for SGM patients and caregivers at the University of New Mexico Comprehensive Cancer Center.

Methods

Between June 2020 and July 2021, we used a multi-methods research design informed by ecological theory to collect qualitative and quantitative data regarding cancer patient and caregiver quality of life (QoL) and experiences of cancer and survivorship care. We used PROMIS measures distributed via REDCap to assess QoL (i.e., fatigue, pain interference, pain intensity, anxiety, depression, emotional support, social isolation, and companionship), and conducted in-depth semi-structured interviews. We recruited 10 SGM cancer patients and 8 heterosexual, cisgender (H/C) patient matches, and their self-identified informal cancer caregivers (n=36, dyad total n=18). Interviews ranged from 1 to 2 hours, were audio-recorded and transcribed for analysis. The study was approved by the University of New Mexico Human Research Protections Office Institutional Review Board.

Results

Results of the PROMIS QoL assessments indicated that SGM patients reported greater anxiety [mean (SD) = 54.5 (8.8)] and depression [mean (SD) = 49.3 (4.8)] than H/C patients [mean (SD)=51.6 (7.5) and 45.4 (6.8) respectively], while heterosexual, cisgender (H/C) patients reported higher fatigue [mean (SD) =52.04 (8.18)] and stronger pain intensity than SGM patients [mean (SD)=48.3 (9.1) and 37.8 (9.1) respectively]. SGM patients reported higher levels of social isolation [mean (SD) = 48.3 (7.3) vs. 42.1 (7.4) for H/C patients, whereas H/C patients reported more emotional support (mean (SD) =57.5 (9.3) vs. 53.0 (6.9)] and companionship [mean (SD) = 55.2 (8.6) vs. 51.5 (11.0)]. SGM and H/C differences in caregiver QoL were most notable with regards to higher levels of fatigue [mean (SD) = 47.1 (6.0) for SGM, and 42.4 (11.5) for H/C] and companionship [mean (SD) = 55.3 (6.0) for SGM, and 50.9 (5.5) for H/C]. Qualitative interviews supported our quantitative results. SGM patients and caregivers articulated experiences of anti-SGM stigma and discrimination contributing to minority stress that influenced their initial cancer care encounters. SGM dyads had more trepidation and/or medical mistrust during initial cancer care encounters when compared to H/C patients and caregivers. SGM patients questioned care that was not culturally responsive to SGM preferences, while H/C patients were more apt to identify gaps in communication and perceived lack of clarity regarding cancer care delivery. Although SGM patients experienced high satisfaction with their cancer care once they developed trust with their providers, they discussed desires to have more direct conversations with their oncologists about their sexual orientation and gender identities and sexual health. All patients and providers in the study (SGM and H/C) appreciated their oncology care teams. All patients and caregivers relied on social networks comprised of friends and family, although SGM patients and caregivers had smaller social networks and relied less on biological family, and single SGM individuals experienced challenges accessing cancer care and struggled with social isolation. We discovered too, that all caregivers, regardless of Sexual Orientation and Gender Identity (SOGI), perceived a lack of support and information pertaining to their loved one's treatment, side effects and best way to provide care.

Conclusions

This study demonstrates that prior stigmatizing experiences contribute to minority stress and medical mistrust for SGM cancer patients and their informal caregivers across the cancer care experience. Findings point to specific gaps in SGM cancer patient care, including lack of conversation about patient SOGI, inadequate staff and oncology provider SGM specific knowledge and cultural competence/cultural humility training, and insufficient patient supports for those who lack social support during cancer care treatment. Further, this study reveals inadequacies in SGM specific support, and overall support services for informal cancer caregivers. Additional research is required to develop targeted interventions to address minority stress and clinic environment concerns to improve cancer care for SGM patients. Importantly, while there were differences between SGM and H/C experiences of cancer treatment, significant similarities also emerged. Caregiver expressed consensus about the current lack of support and guidance for informal caregivers of cancer patients. Future work should focus on providing caregiver-specific resources in the clinic setting and facilitating support groups for caregivers to network with one another, as well as for tailoring SGM specific caregiver support services. Our findings highlight areas for improving cancer care for the SGM community, as well as a broader population of patients and caregivers.

Relationships between care burden, resilience, and depressive symptoms among the main family caregivers of stroke patients: A cross-sectional study

OBJECTIVES

This study aims to explore the potential mediating role of resilience between care burden and depressive symptoms in family caregivers of stroke patients.

METHODS

A cross-sectional study was conducted with a convenience sample involving 245 main family caregivers of stroke patients recruited from the neurology department of a Tertiary A hospital in China. Mediation analyses were conducted using the PROCESS macro (Model 4) for SPSS, applying the Bootstrap analysis with 5,000 samples and a 95% confidence interval.

RESULTS

The results showed that with constant hemiplegia side, Barthel Index, education level, monthly income, care time per day, and living with patients in regression equations, the resilience partially mediated the correlation of care burden and depressive symptoms with a mediation effect ratio of 26.32%.

CONCLUSIONS

Resilience plays a mediating role in the correlation between care burden and depressive symptoms.

IMPACT

The findings indicated a protective effect of resilience in alleviating the negative influences of care burden on depressive symptoms, suggesting that resilience-training intervention may be developed to mitigate depressive symptoms of the main family caregivers of stroke patients.