Study On The Factors Influencing The Quality Of Life Among Family Caregivers Of Primary Liver Cancer Patients With TACE

Background Primary liver cancer is one of the most common malignancy and The incidence is upgrading in The wordwild, with more than 50% of the cases and deaths in china. TACE is recommended as the main palliative treatment alone or in combination with surgery,radiation therapy, Radiofrequencey Ablation. liver cancer is a serious traumatic event for the entire family,Symptom burden of the disease or treatment is profound and impacts the patient as well as the family caregiver (FCG) who supports the patient. FCGs face multiple challenges throughout the illness trajectory.Research suggests that most caregivers of cancer patients are plagued by shock, frustration,anxiety, depression and caregiver burden. with the potential for disease progression,long-term care hallenges of their roles impacts their ability to continue care for their family member through the illness trajectory,then in turn impacts care quality. So, assessing, and addressing the challenges and burdens of the FCG are integral to caring for and supporting the patient. Examining live cancer’s impact on a FCG’s quality of life (QOL) is one way to better understand the questions above-mentioned. QOL was defined as "a personal perception of health and fuction, including physiology, emotiona, spirit, social, behavior and so on,influend by disease,treatment, personal traits, socioeconomic status,is a multidimensional concept.".Relatively few studies have focused simultaneously on patients with cancer and their caregivers, and even fewer are devoted to liver cancer patients and their family caregivers.The purpose of the article is to (a) describe the the patient’s characteristics,symptom burden and the caregiver’s reactions to the demands of caregiving, how these relationships progress over time, and potential risks for caregivers succumbing to the burden of caregiving,whose impair FCG’s QOL. The design of the study was based the cognitive stress theory of Lazarus and Folkman, in combination with Stress response theory, Cancer family care experience conceptual model.Their model postulates that patient and caregiver characteristics impact caregiver experiences, and all of these in turn affect the health of the caregiver. Thus, we assume that patient and caregiver characteristics impact caregiver experiences/reaction over time, and all of these in turn affect the mental and physical health of the caregiver over time,verifyied by structural equation model.ObjectivesTo build the model of quality of life of primary liver cancer patients caregivers;verify the hypothesis and explain the model, analyze the direct and indirect relationship between the variablesMethodsThis study includes three parts:the Theoretical research,the cross-sectional study and the Longitudinal survey.First, through the theoretical research,we come up with the hypothesis of this study. To verify this hypothesis,we Collect 501 patient-caregiver dyads of liver cancer patients receiving transcatheterhepatic chemoembolization in Zhong Shan hospital,which is affiliated to Fudan University.The Common Status Questionnaire、Memorial Symptom Assessment Scale (MSAS),The Center for Epidemiological Studies Depression Scale (CES-D) were used respectively to investigate the demographic and socioeconomic data,disease data,Symptom burden,depression.The Common status Questionnaire,Quality of Life of Family Version (QOL-scale FAMILY),CES-D,Caregiver Reaction Assessment(CRA),SRB,Social Support Rating Scale(SSRS) were used respectively to investigate the demographic and socioeconomic data.Quality of Life,Depression,Caregiver Reaction,Caregivers’Burdens,social support conditions.Results1. Develped the symptoms specific to primary liver caner with TACE and Revised QoLScale-FAMILY Applying in liver caner patients caregivers;The symptom module specific to primary liver caner consisted of 3 symptom items including fever,jaundice,hiccup. The content validity is 0.95. Item 5,34,35,18 and 23,24,30,31 and 32 were deleted because of factor loading of<0.40 and low response. We performed the factor analysis and showed four factor loadings, which were labeled as the subscales of physical well-being (items 1,2,3,4,6and 9),psychological well-being (items 7,8,10,11,12,36 and 37), social well-being (items 24,26,27,28,29 and 33), family concerns (items 13,14,15,16,17,19,20and 22). A confirmatory factor analysis confirmed the construct validity of the questionnaire(GFI=0.959,AGFI=0924,CFI=0.985,RMSEA=0.031,x2/df=1.472).2. Model of quality of life of primary liver cancer patients caregivers is reasonable;(1) Structural equation model analysis showed that that depression had a significantly main effect on QOL,B=(--380)-(-.490), p<0.05.The physical well-being,psychological well-being of Qol was directly predicted by depression B(-0.214)-(-0.333),p<0.05),and noticeably,the CRA mediated between the depression and the QOL,B=(-.157)-(-.353);(2) Multiple factors analysis showed social support,patients’depression,GDl symptom burden,care burden,time disturb significant effected depression (p<0.05),Explain 24.7% of the variance. Structural equation model analysis showed that negative response significant effected depression(B=0.525,p<0.05). Negative response taked as a median role beween the social support patients’depression,GDI symptom burden,care burden and depression;(3) Social support indirect influenced depression and OOL; negative response taked as a median role;(4) Self-esteem taked as a median role, positively related to social support and psychological status of FCG.,Negatively correlated to patients’depression and family concerns;(5) Negative response positively related to patients’depression and FCG’s depression, Negatively correlated to social support.Conclusion:1. That both the ordering of the factor loadings and factors construction of the scales were influenced by prevailing characteristics of different cancers. Psychometric validation of the Quality of Life scales demonstrates that these culturally and Specificity adapted scales are valid and reliable tools to assess the QOL of chinese family caregivers of liver cancer patients.2. Our findings suggest that physicians, nurse and other health care providers involved in the care of cancer patients should be cognizant of the demands put on caregivers. Periodic assessments and dialogue with the caregiver about their experiences, needs and concerns. To improve their ability as the role and provide high quality care for patients.3. We should pay close attention to caregivers’QOL. Taking advantage of the positive significance of caring and strengthening education work and improve social support to improve the FCG quality of life and care quality.