Advance Care Planning Completion and Decision-Making Among Older Adults With Cancer and Their Family Caregivers: Findings From a Mixed Methods Study

BackgroundAdvance care planning (ACP) is a complex process where individuals communicate decisions about their future health care before becoming incapable to participate in medical decision-making. While ACP has many potential benefits, little is known about ACP among older adults with cancer and their family caregivers. The purpose of this study is to examine holistic factors that affect ACP in older adults with cancer and how family caregivers engage in the process.MethodsThis study used explanatory sequential mixed methods design guided by Engel's Biopsychosocial model. Phase I included secondary analysis of 1088 decedents over 55 years of age, using data from 2002-2016 waves of exit interviews of the Health and Retirement Study. Phase 2 included semi-structured interviews with a convenience sample of 14 family caregivers. Quantitative and qualitative findings were integrated using a joint display.ResultsQuantitative findings showed that over half of participants had all 3 types of ACP (end-of-life care discussion, durable power of attorney, advance directives) and all 3 types were significantly associated with age, race, education, multimorbidity, limitations in activities of daily living and instrumental activities of daily living, and marital status. Qualitative findings revealed that most participants had no knowledge about ACP. Integration identified points of convergence and divergence in knowledge, documentation, and factors affecting ACP.ConclusionsFuture studies are needed in a diverse sample of older adults with cancer and their family caregivers to understand and improve discussion and documentation of ACP. Findings also suggest the need for interventions to improve knowledge and awareness of ACP in this population.

The assessment of care burden and influencing factors on family caregivers for cancer patients

BACKGROUND

The family caregivers as primary caregivers play a crucial role regarding the care of cancer patients. As defined in the literature, the care burden encompasses the negative objective and subjective outcomes including psychological and physical health problems, economic and social issues, deterioration of family relationships and feelings of loss of control that arise from caregiving responsibilities.

AIMS

This study aims to assess the care burden and to evaluate the associated factors among family caregivers of cancer patients receiving treatment at a state hospital in Türkiye.

METHODS

This cross-sectional study was conducted with the family caregivers of patients undergoing treatment in the radiation oncology department of a state hospital in Türkiye. The study population consisted of 350 individuals, with a participation rate of 80%. Participants were administered a questionnaire concerning determining daily living activities and identifying the caregiving burden through their socio-demographic characteristics.

RESULTS

The care burden among primary family caregivers while the delivery of health services was severe for 85.1% of them. The average ZBI score of caregivers was 55.92 ± 14.58. It was clarified that family caregivers' burden was influenced by several factors, including the duration of caregiving, difficulties experienced while caring for the patient, and the negative impact on their daily roles.

CONCLUSION

Our study's findings indicate the need for health professionals to support caregivers of cancer patients while over half of the caregivers were identified as having a severe level of caregiving burden. It is important to raise awareness among nurses and the oncology team with a holistic approach. In the delivery of health services, caregivers' needs should be identified first, support mechanisms should be activated and interventions should be made to meet these needs.

IMPACT

This study's findings highlight the need to identify and problems faced by family members during caregiving. This is important for sustainable and cost-effective holistic care.

REPORTING METHOD

The results of this study are reported based on the guidelines of The Strengthening the Reporting of Observational Studies (cohort, case-control studies, cross-sectional studies) in Epidemiology (STROBE).

IMPLICATIONS FOR PRACTICE

Our study's findings indicate the need for health professionals to support caregivers of cancer patients. It is important to raise awareness among nurses and the oncology team with a holistic approach. In the delivery of health services, caregivers' needs should be identified first, support mechanisms should be activated and interventions should be made to meet these needs.

The Magnitude of Care Burden and Associated Factors in Caregivers of Children with Cancer at the Country's Largest Tertiary Referral Hospital, Ethiopia: A Cross-Sectional Study

Objectives. Many caregivers who care for their children with cancer are affected by the care burden due to the chronic nature of the disease. This study aimed to determine the burden of care level and its related factors in the caregivers of children with cancer. Methods. A facility-based, cross-sectional study was conducted at Tikur Anbessa Specialized Hospital. Children diagnosed with cancer and treated at the hospital between July 1 and August 1, 2023, and their caregivers were included. The data were analyzed using SPSS version 25. Descriptive analysis and inferential statistics were used to summarize the data and to determine the association with the dependent variable. Statistical significance was set at P < .05. Results. A total of 208 children with cancer and their caregivers were included in the study. Most children (81, 38.9%) were below 5 years of age, and 80.3% (n = 167) of the patients came from out of Addis Ababa. The most common type of childhood cancer was haemato-lymphoid cancer (n = 117, 56.3%). The mean duration of cancer care after diagnosis was 289.55 days. The median age of caregivers was 35 ± 8.7 years, most of the caregivers were parents of the child (n = 185, 88.9%), married (n = 186, 87%), had a primary level education (n = 66, 31.7), and 87.5% (n = 182) had insufficient income for the cancer treatment cost. The average caring time was 19 to 24 hours for 76.4% (n = 159) of caregivers, and more than one-fourth of caregivers (n = 57, 27.4%) intended to abandon treatment if they couldn't get support to continue the care. The mean care burden in caregivers was 65.76 ± 14 and about, 53.4% (n = 111) and 35.1% (n = 73) of caregivers had moderate and severe care burden. Binary logistic analysis showed the factors associated with an increased care burden were the caregiver's occupational status (P = .034, 95 % CI; AOR (0.064, 0.890)), lack of support from NGOs (P = .037, 95 % CI; AOR (1.053, 5.254), and insufficient monthly income for the treatment (P = .034; 95% CI; AOR (0.064, 0.896)). Conclusion. Most of the caregivers of children with cancer were parents and had insufficient income for the treatment. More than one-fourth had an intention to abandon the cancer treatment. Most caregivers had moderate to severe care burdens.

Perceptions of Stress and Engagement in High-Intensity Caregiving: A Cross-Sectional Study in Lithuania

The aging population and overstretched healthcare systems are increasing demand for home nursing by informal caregivers, significantly affecting their mental health. This study aimed to examine the level of population's engagement in caregiving and the association between high-intensity caregiving and perceived caregiving stress in the general population of Lithuania. A nationally representative sample (N = 1000) of Lithuanian residents aged 18 years and older (mean age 53.1 ± 17.9 years) was interviewed in their households. The results showed that 17.4% (95% CI: 15.1, 19.8) of respondents were involved in home nursing activities to some extent, with 42% of these being high-intensity caregivers (providing 11 or more hours of home care per week). Caregivers were statistically significantly more likely to be female and have higher education levels. Perceived stress was significantly associated with higher education levels (OR = 2.66, 95% CI: 1.41, 5.02), high-intensity caregiving (OR = 2.14, 95% CI: 1.15, 3.97), regular involvement in home nursing (OR = 1.86, 95% CI: 1.01, 3.43), and caring for recipients with dementia or individuals entirely dependent on assistance (OR = 2.52, 95% CI: 1.22, 5.23). Caregivers perceived stress is associated with their level of education, the intensity and regularity of home nursing, as well as the level of dependency of the care recipient, especially in cases of dementia. Comprehensive long-term care policies should be developed to ensure the larger availability of formal care resources, increased societal participation in home nursing, and tailored interventions for high intensity caregivers.

Morbidity and healthcare use among mothers of children with cancer: A population-based study

BACKGROUND

The impact of a child's cancer diagnosis on subsequent maternal physical health is unclear.

METHODS

We identified all Ontario children diagnosed less than 18 years with cancer between 1992 and 2017. Linkage to administrative databases identified mothers who were matched to population controls. We identified physical health conditions, acute healthcare use, and preventive healthcare use through validated algorithms using healthcare data, and compared them between exposed (child with cancer) and unexposed mothers. Predictors of health outcomes were assessed among exposed mothers.

RESULTS

We identified 5311 exposed mothers and 19,516 matched unexposed mothers. For exposed mothers, median age at last follow-up was 48 years, (interquartile range: 42-53). Exposed mothers had an increased risk of cancer (hazard ratio [HR] 1.2, 95% confidence interval [95% CI]: 1.0-1.5, p = .03), but not of any other adverse physical outcomes or of increased acute healthcare use. Exposed mothers were more likely to receive influenza vaccinations (odds ratio 1.4, 95% CI: 1.3-1.5, p < .0001), and underwent cancer screening at the same rate as unexposed mothers. Among exposed mothers, bereavement was associated with a subsequent increased risk of cancer (HR 1.7, 95% CI: 1.2-2.5, p = .004) and death (HR 2.2, 95% CI: 1.2-4.1, p = .01).

CONCLUSION

Mothers of children with cancer are at increased risk of developing cancer, but not of other adverse physical health outcomes, and were equally or more likely to be adherent to preventive healthcare practices. Bereaved mothers were at increased risk of subsequent cancer and death. Interventions targeting specific subpopulations of mothers of children with cancer or focused on screening for specific cancers may be warranted.

The Effect of Education and Telephone Follow-up on the Burden of Family Caregivers of Patients With Cancer

Introduction

Family caregivers of patients with cancer face a care burden due to the responsibilities and problems of providing care to the patients. Applying appropriate strategies to reduce the burden is essential.

Objective

The study aimed to determine the effect of education and telephone follow-up on family caregivers' burden on patients with cancer.

Methods

In this quasi-experimental study, 69 family caregivers of patients with cancer referred to only one chemotherapy center of a hospital in Lorestan province in Iran were recruited by convenience sampling method. They were randomly assigned to intervention (n  =  33) and control (n  =  36) groups. For the intervention group, two face-to-face training sessions and six telephone counseling sessions were held related to the care of the patients and self-care. The control group received only routine care. The family caregiver burden was measured by Novak and Gast Caregiver Burden Inventory (1989) completed before, immediately, and 6 weeks after the study. Data were analyzed by SPSS21 using independent t-tests, paired t-tests, and repeated measures.

Results

Both groups were homogeneous regarding demographic characteristics and the baseline care burden. The caregiver burden decreased significantly in the intervention group, so its score was 77.33  ±  8.49, 58.93  ±  8.03, and 52.78  ±  6.86 before the study, immediately after and 6 weeks later, respectively (p < .001). In the control group, there were no significant changes.

Conclusion

Education and telephone counseling reduced the burden on family caregivers. Therefore, this type of support is beneficial for providing holistic care and preserving the health of family caregivers.

Cultural factors associated with burden in unpaid caregivers of older adults: A systematic review

The aim of the present systematic review was to investigate cultural factors associated with burden in unpaid caregivers of older adults. Searches were conducted in the Pubmed, Web of Science, PsycInfo, Scopus, Embase, LILACs and SciELO databases for relevant articles published in English, Portuguese and Spanish using the search terms 'Caregiver AND Culture AND (Burnout OR Caregiver Burden) AND Aged'. No restriction was imposed regarding year of publication. A total of 1234 articles were identified, 34 of which were selected for the present review. The following sociodemographic characteristics were associated with burden: being female, married, White caregivers, young and the spouse of the care recipient; having no siblings; having low schooling and low economic status. Cultural factors associated with burden were living with the care recipient, not professing a religion or having little spirituality, familism (i.e. less reciprocity) and an absence of social support. The present findings underscore the importance of developing intervention strategies that consider cultural factors to minimise the negative impacts of care on unpaid caregivers of older adults.

Psychological predictors of quality of life among Jordanian cancer patients' caregivers

OBJECTIVE

The caregivers who provide care for patients with cancer often experience emotional and psychological stressors and burdens that could be influenced by several factors, including the cultural context. This study examines the level of emotional distress and burden and their effect on the quality of life (QOL) of Jordanian cancer patients' caregivers.

METHODS

A cross-sectional survey was conducted among 257 family caregivers of patients at various stages of cancer.

RESULTS

The average age of caregivers was 37.5 years (SD = 12.2). Most caregivers (145; 59.2%) were female and married (168; 68.6%). About a quarter were partners (32.2%) and lived with their patients (137; 55.9%). Caregivers with a reduced overall Caregiver Quality of Life Index-Cancer (CQOLC) score were more likely to be older, the parents of the patients, and living with patients in the same house. A significant negative relationship was found between caregivers' CQOLC and Zarit Burden Interview (r = -0.7, p = 0.001), anxiety (r = -0.69, p = 0.001), and depression (r = -0.42, p = 0.03) scores. Multiple linear regression analysis revealed that burden, anxiety, and depression scores were independent predictors and explained 63% of the variance in the total CQOLC score of caregivers.

CONCLUSION

Cancer caregivers are at elevated risk of poor QOL. Despite participants' low perception of the burden level, this study provides preliminary results for policymakers and medical practitioners to foster a comprehensive platform supporting cancer caregivers. Moreover, identifying the caregivers' readiness to provide the needed care and the availability of supportive resources, as a clinical routine, is strongly recommended.

Care burden and associated factors in caregivers of children with cancer

BACKGROUND

Evidence suggests that many parents who care for their children with cancer are affected by the care burden due to the chronic nature of the disease. The aim of this study was to determine the burden of care level and its related factors in the caregivers of children with cancer.

METHOD

A total of 270 caregivers of children with cancer were included in this cross-sectional study by convenience sampling method. Data collection tools were a personal information form and the Novak & Guest's Caregiver Burden Inventory. Data were analyzed by descriptive and inferential statistics (chi-square and univariate linear regression model).

RESULTS

The mean ages of caregivers and patients were 35.7 ± 7.0 and 3.1 ± 1.6 years, respectively. The mean care burden was 68.4 ± 1.5 out of 120. About 50 and 36% of caregivers had moderate and severe care burden, respectively.

CONCLUSION

Caregivers had moderate to high care burden. A number of factors associated with care burden were identified. Health authorities need to take family-centered measures to reduce the burden of caregivers.

Analysis of Factors Related to Spiritual Psychology and Quality of Life in Patients with Inflammatory Bowel Disease Based on Artificial Intelligence IBD Nursing Technology

To investigate the characteristics of psychological symptoms in inflammatory bowel disease (IBD), to study the relationship between psychological symptoms and quality of life, and to provide some theoretical basis for the corresponding psychological treatment of IBD patients with psychiatric abnormalities. With the development of artificial intelligence (AI) and its gradual application to the medical field, it has brought new ideas to the medical development, and its research and application in IBD, including ulcerative colitis (UC) and Crohn's disease (CD), is increasing. Machine learning is used to select reasonable models and methods to help the prediction, diagnosis, treatment, and prognosis of IBD. In this study, we improved on the classical unidirectional LSTM model by adding backward and forward LSTM layers, designed a bidirectional LSTM model to improve the shortcomings of unidirectional LSTM with insufficient dependence on the posterior, introduced the contribution rate α to adjust the weight matrix of the forward LSTM layer and the backward LSTM layer, and experimentally verified the correctness and superiority of the proposed model. A total of 159 patients with IBD and 89 healthy people were collected and psychologically assessed using the general status questionnaire, the 90-item symptom checklist (SCL-90). Patients with IBD are prone to a combination of obsessive-compulsive, interpersonal, depressive, hostile, and other abnormal psychological symptoms, and their quality of life is significantly reduced; quality of life is mainly affected by disease condition, depression, interpersonal sensitivity, and paranoia, and patients in the active stage of the disease with heavy symptoms of depression, paranoia, and interpersonal sensitivity have low quality of life.

Prevalence and determinants of stress of informal caregiving: A cross-sectional study among informal caregivers of hospitalised patients in a tertiary hospital in Nigeria

Background

Caring for patients in the hospital can cause a lot of stress for the caregivers, especially those who are involved with informal caregiving such as family members. Little is known in Nigeria on the stress of informal caregiving in the hospital environment. This study assessed the informal caregivers' stress level and their determinants in a tertiary hospital in Ilorin, Nigeria.

Methodology

This was a hospital-based cross-sectional study. Between September and October 2019, using a simple random sampling method, data were collected from 400 informal caregivers of patients in University of Ilorin Teaching Hospital with interviewer-administered questionnaire which included socio-demographic characteristics, Caregivers Strain index (CSI) and caregivers' stress from institution and other factors index (CSIOI). Analysis was performed, and prevalence and determinants of stress of informal caregiving were presented using descriptive statistics and logistic regressions. P < 0.05 was considered statistically significant.

Results

The majority, 381 (95.2%) of the informal caregivers, reported great stress levels using CSI, while 227 (56.7%) experienced a great level of stress with the CSIOI. Predictors of caregiver stress were perception that staying around was stressful (odds ratio [OR] - 17.5, P < 0.001), felt their patients will not be well cared for if not around (OR - 6.1, P < 0.001), staying at the hospital for >30 days (OR - 2.6, P = 0.001).

Conclusion

The informal caregivers experienced a great level of stress taking care of their patients on admission in the hospital. It is, therefore, expedient that issues surrounding the comfort of the informal caregivers as they care for their patients should be included in hospital policies.

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.

Caregiver burden among family caregivers of incurable cancer patients in two eastern Mediterranean countries

Background

Although family caregivers (FCs) play an important role in the care provided to incurable cancer patients in our region, little is known about the burden they experience.

This study was conducted to determine the prevalence of caregiver burden (CB) among FCs of incurable cancer patients in two Eastern Mediterranean countries and to identify factors that may be associated with significant CB.

Methods

The study included 218 FCs, 165 from Egypt and 53 from Saudi Arabia. The 22-item Zarit Burden Interview (ZBI-22) was used to assess caregiver burden CB. Significant CB was defined as a ZBI-22 score ≥ 21. The assistance with basic ADLs was classified into 3 levels according to FCs’ assistance with early/middle/late-loss basic ADLs. The relationship between CB and the assistance with ADLs and other factors was studied.

Results

The mean (SD) ZBI-22 score among FCs was 23.4 (9.3) and the majority (128/218, 59%) had significant CB. Eighty-nine percent of FCs assisted with at least one basic ADL. Assistance with late-loss basic ADLs, best supportive care treatment plan and poorer performance status were associated with higher CB (p < 0.0001, =0.018 and = 0.005). However, in logistic regression analysis, only assistance with late-loss ADLs was independently associated with significant CB (OR = 3.4 [95%CI:1.2–9.7], p = 0.024).

Conclusion

A substantial proportion of FCs of incurable cancer patients in our region experience significant CB. Family caregivers assisting with late-loss basic ADLs are at risk of significant CB and should be routinely screened for CB.

Self-care, resilience, and caregiver burden in relatives of patients with advanced cancer: results from the eQuiPe study

PURPOSE

Relatives are often involved in caregiving for patients with advanced cancer and carry a heavy burden. Self-care and resilience might be beneficial to enhance their wellbeing and burden-bearing capacity. This study assessed the engagement in self-care and resilience in relatives of patients with advanced cancer and its association with their caregiver burden.

METHODS

This study analyzed baseline data of the eQuiPe study, a prospective longitudinal, multicenter, observational study on quality of care and life of patients with advanced cancer and their relatives in which self-care (Self-care Practices Scale), resilience (Connor-Davidson Resilience Scale), and caregiver burden (Zarit Burden Interview (ZBI)) of relatives were included. Their scores were compared with a gender- and age-matched normative population. Multivariable logistic regression analysis was performed to assess the association between self-care and resilience with caregiver burden.

RESULTS

Most of the 746 relatives were the patient's partner (78%) and 54% reported to be an informal caregiver of the patient. The median hours of caregiving a week for all relatives was 15 and 11% experienced high caregiver burden (ZBI > 20). Relatives who reported a high caregiver burden engaged less often in self-care (OR = .87) and were less resilient (OR = .76) compared to relatives with low/medium caregiver burden. Relatives with high caregiver burden were younger (OR = .96), highly educated (OR = 2.08), often reported to be an informal caregiver of the patient (OR = 2.24), and were less well informed about the importance of self-care (OR = .39).

CONCLUSION

A significant number of relatives of patients with advanced cancer experienced high caregiver burden. As more self-care and resilience were associated with lower experienced caregiver burden, creating awareness of the beneficial potential of self-care is important. Future studies should illuminate the causal relation.

TRIAL REGISTRATION NUMBER

NTR6584 (date of registration: 30 June 2017).

Preferences of quality delivery of palliative care among cancer patients in low- and middle-income countries: A review

BACKGROUND

All forms of cancer pose a tremendous and increasing problem globally. The prevalence of cancer across the globe is anticipated to double over the next two decades. About 50% of most cancer cases are expected to occur in low- and middle-income countries (LMICs), where there is a greater disproportionate level in mortality. Access to effective and timely care for cancer patients remains a challenge, especially in LMICs due to late disease diagnosis and detection, coupled with the limited availability of appropriate therapeutic options and delay in proper interventions.

METHODOLOGY

This study explored several mixed-method researches and randomized trials that addressed the preferences of quality delivery of palliative care among cancer patients in LMICs. A designated set of keywords such as Palliative Care; Preferences; Cancer patients; Psycho-social Support; End-of-life Care; Low and Middle-Income Countries were inserted on electronic databases to retrieve articles. The databases include PubMed, Scinapse, Medline, The Google Scholar, Academic search premier, SAGE, and EBSCO host.

RESULTS

Findings from this review discussed the socioeconomic and behavioral factors, which address the quality delivery of palliative care among cancer patients. These factors if measured with acceptance level in cancer patients could help to address areas that need improvement from the stage of disease diagnosis to the end-of-life.

SIGNIFICANCE OF THE RESULTS

Valuable collaborations among international and local health institutions are needed to build and implement a systematic framework for palliative care in LMICs. Policies and programs that are country and culturally specific, encompassing both theoretical and practical models of care in the milieu of existing quandaries should be developed.

Quality of Life and Associated Factors Among Family Caregivers of Adult Cancer Patients in Addis Ababa, Ethiopia

Background

Cancer has a major impact on the lives of family caregivers, including their health and quality of life (QOL). However, little is known about the QOL of family caregivers of adult cancer patients in Ethiopia. This study aimed to assess the QOL and associated factors among primary family caregivers of adult cancer patients in Addis Ababa, Ethiopia.

Methods

In this cross-sectional study, 291 family caregivers completed the survey in the Amharic language. The Caregiver Quality of Life Index-Cancer (CQOLC) was used to measure QOL of family caregivers. Descriptive and linear regression analyses were conducted using SPSS version 23.

Results

The mean age of the family caregivers was 37.04±11.47 years and 51.5% were male. The mean score of QOL was 82.23 (±16.21). Not being employed in private sector (β = -0.128; CI=-7.82, -0.45; p= 0.028), having family monthly income less than 16 USD (β = 0.132; CI=0.87, 10.88; p= 0.021) and not having family monthly income greater than 64 USD (β = -0.128; CI= -10.43, -0.66; p= 0.026), being spouse (β = 0.179; CI: 1.34, 11.99; p= 0.019) and not residing in urban areas (β = -0.139; CI: -10.53, -0.96; p= 0.019) were negatively associated with the QOL of the family caregiver and explained 8.7% of the variation (R² =0.087; p=0.000).

Conclusion

Our findings identified factors such as occupation, income, relationship with the patient, and place of residence that negatively associated with the QOL of family caregivers. Targeted interventions such as social and economic support and bringing the care to the patient's residence place are needed to improve the QOL of family caregivers of adult cancer patients.

Roles of Family Caregivers and Perceived Burden When Caring for Hospitalized Adult Cancer Patients: Perspective From a Low-Income Country

BACKGROUND

Family caregivers (FCGs) of adult cancer patients (ACPs) are typically involved in the entire trajectory of cancer disease, from diagnosis to survivorship or end of life. In developing countries, FCGs are more intensely involved in the process of providing care to the hospitalized ACPs because of lack of adequate cancer care resources. Active performance of tasks to meet the needs of ACPs in the hospital setting is likely to elicit significant caregiver burden.

OBJECTIVE

The aim of this study was to explore the tasks performed and the caregiver burden experienced by FCGs of hospitalized ACPs in a sub-Saharan country.

METHODS

A cross-sectional descriptive design was used to collect data from 168 FCGs of ACPs. The Caregiver Burden Scale was used to measure burden.

RESULTS

The most common cancer diagnosis in male and female ACPs was Kaposi's sarcoma (32.1%) and breast cancer (37.9%), respectively. The tasks regularly performed by most FCGs for the ACPs were providing emotional support (79.8%), feeding (68.5%), transporting to other appointments (62.5%), preparing meals (55%), and giving medications (46.4%). Most FCGs (75%) were experiencing severe or very severe general caregiver burden. The dimensions of caregiver burden that were most severely impacted were general strain (70.6%), disappointment (85.8%), and isolation (72%). Predictors of caregiver burden are reported.

CONCLUSION

Family caregivers of hospitalized ACPs experience severe caregiver burden. The main forms of burden experienced were general strain, disappointment, and isolation.

IMPLICATIONS FOR PRACTICE

Cancer care services in developing countries should be strengthened with services that address FCGs' emotional needs and human resources to curtail the strain imposed on FCGs.

Perception of a "good death" in Thai patients with cancer and their relatives

Background

Understanding the perceptions regarding what constitutes a "good death" among cancer patients and their families could help healthcare teams to ensure proper palliative and supportive care.

Objectives

To demonstrate and compare the wishes cancer patients and the perceptions of their relatives regarding end-of-life care, and to identify factors associated with patients' preferences regarding place of death.

Methods

A sample of cancer patients and their relatives who attended the Srinagarind Hospital (Thailand) oncology clinic or day chemotherapy from September 2017 to August 2018 were enrolled. Questionnaires were given to the participants, in which the patients were asked to respond based on their own end-of-life preferences, and relatives were asked to imagine how the patients would respond to the questions.

Results

One hundred eighty pairs of patients and relatives were recruited. Respondents in both groups placed importance on place of death, relationship with family, physical and psychological comfort, and relationship with the medical staff. Both groups generally agreed with the statements on the questionnaire (10/13 statements). Relatives underestimated the preferences of the patients in 3 areas: "not being a burden to others," "preparation for death," and "physical and psychological comfort." Being married (adjusted odds ratio (AOD) 6.4, 95%confidence interval (CI) 1.1,36.5), having had more than 6 years of education (AOD 6.5, 95%CI 1.8,23.7), having lung cancer compared to colon cancer (AOD 12, 95%CI 1.2,118.7), duration after cancer diagnosis (AOD 0.9, 95%CI 0.93,0.99), previous hospital admission (AOD 5.7, 95%CI 1.5,21.2), and life satisfaction (AOD 17.6, 95%CI 2.9,104.9) were factors associated with preference for home death.

Conclusion

Thai cancer patients and their relatives indicated similar preferences with regard to what constitutes a good death and patients' wishes for their end-of-life period. However, the patients' relatives underestimated the importance patients placed on statements in three domains. Factors that influenced a preference for a home death were identified.

The Development of the Community-based Palliative Care Model in a District Health System, Phitsanulok Province, Thailand

Context:

Palliative care (PC) refers to a set of basic health services in Thailand and is in the early stage of implementation.

Aim:

The aim of this study is to develop a community-based PC model in a district health system (DHS) based on the form of action and evaluation.

Methods:

A three-step action research: look, think, and act was designed with mixed methods of data collection.

Results:

A key finding was the confusion on the terminology of the PC, challenge of the referral system of PC patients in DHS, medical equipment and supplies for the PC patients, and insufficient access to opioid analgesics at home. The model of development comprised the training of health professionals, the management of the medical equipment and supplies by people sector, and the development of a referral guideline of the PC patient in DHS. The evaluation showed the higher score of the accessibility to PC than the score of accommodation for patients. It also showed the higher score of the care continuity over the longitudinal continuity for patients. For the carers, the score of guilt is higher than the score of the care burden.

Conclusions:

A community-based PC model should be monitored by district health managment. The methods of this study are expected to be useful advice on how to solve similar problems in the other regions of similar context.

Hospital-based Population of Elderly Cancer Cases in Northeastern Thailand

BACKGROUND

The proportion of aged Thais (≥65 years old) is expected to be 30% by 2030, leading to an increased number of elderly cancer cases. Older individuals have distinct patterns of cancer and treatment needs. We therefore conducted the present study of new cancer cases and trends to get a perspective on the elderly cancer situation in Northeast Thailand.

MATERIALS AND METHODS

All new elderly cancer cases (≥65 years) registered in the hospital-based cancer registry at the Faculty of Medicine, Srinagarind Hospital, Khon Kaen University during 1993-2012 were included in the study.

RESULTS

Elderly patients accounted for 31.6% of all cancer patients and new cancer cases in the older age group increased 46% from the first to second decades. The absolute number of oldest old (80+ years) doubled. The top three cancers in males were liver and bile duct, lung, and colorectal. In females, the three most common cancers were liver and bile duct, oral cavity, and cervix. Cancers with the highest percentages of increase were thyroid, prostate, and colorectal.

CONCLUSIONS

Elderly cancer cases are increasing. Treatment modalities and palliative care for older populations are urgently needed.