| Objective:To describe hope level and QOL among the family caregivers of advanced cancer. To determine the relationship between hope and QOL and their influencing factors. To explore the feasibility and effectiveness of LWHP in improving hope level and QOL among family caregivers of advanced lung cancer in China. Methods:1.369 pairs of hospitalized advanced cancer patients and their family caregivers from five hospitals of Shannxi province were selected as a convenience sample. The general information questionnaire, Herth hope Index Scale(HHI) and the World Health Organization Quality of Life Short Form(WHOQOL-BREF) were used to assess demographics of patients and their caregivers, caregivers’ hope level and their quality of life. Epidata 3.0 was used to establish a database and SPSS17.0 was used to analysis the data.2. A randomized controlled trial was conducted by selecting 60 family caregivers of advanced lung cancer patients in Respiratory department of Xijing Hospital.The subjects were randomly divided into intervention and control groups to explore the impact of hope level, self-efficacy, anxiety, depression and quality of life by LWHP. Epidata 3.0 was used to establish a database and SPSS17.0 was used to analysis the data. The hope diaries were used QSR Nvivo10.0 software to analysis. Results:1. The family caregivers of advanced cancer patients’ hope level and QOL(1) The hope level of 369 family caregivers of advanced cancer was in the moderate to high levels of hope. The total HHI score were 36.57±4.65. The constituent ratio of each part of was: low(1.1%), moderate(40.1%) and high(58.8%). Hope level was significantly associated with evaluated physical condition of the patient by caregiver, caregiver support utilization, objective and subjective support, the total monthly household income and age.(2) The score of physical QOL was 13.02±2.64, mental QOL was 13.24±2.63, social relation score was 13.34±3.04 and environmental score was 12.53±2.33. The physical QOL, mental QOL, social relations score were lower than the norm. The evaluated physical condition of the patient by caregiver, the total family income, the cumulative time for caregiving, the number of children, spouse caregiver, the degree of economic difficulties, objective support, subjective support and caregiver support utilization were major factors affecting their QOL.(3) The relationship between hope and QOL is positive. Higher levels of hope indicated higher QOL. Social support is a moderate variable between hope and QOL.2. The impact of LWHP intervention in family caregivers of patients with advanced lung cancer and the analysis of their hope diary(1)The impact of LWHP interventionRepeated measures analysis of variance showed that:①The main intervention effect on the overall hope, self-efficacy, anxiety and depression, mental health were significant(P<0.05),while the physical health was not significant(P>0.05);②The main time effect on the overall hope, self-efficacy were significant(P<0.05),while the anxiety and depression, physical and mental health were not significant(P>0.05);③The interaction between intervention and time on the overall hope, self-efficacy, anxiety and depression, mental health were significant(P<0.05),while the physical health was not significant(P>0.05).There were no significantly different(P>0.05) between intervention and control group with the hope level, self-efficacy, anxiety and depression, mental and physical health at T0 and T1. The hope level, self-efficacy and mental health scores were significant(P<0.05) higher than the control group at T2, T3 and T4, the anxiety scores were significant(P<0.05) lower than the control group at T2, T3 and T4, the depression scores were significant(P<0.05) lower than the control group at T3 and T4, the mental health were significant(P<0.05) higher than the control group at T3.The score of hope level, self-efficacy, mental and physical health were higher than the previous time point in intervention group(P<0.05). The anxiety and depression score were lower than the previous time point in intervention group(P<0.05); The anxiety and depression score were higher than the previous time point in control group(P<0.05); The mental health score were lower than the previous time point in control group(P<0.05) while the self-efficacy, physical health scores showed no significant difference between the 5 points in control group(P>0.05).(2) Analysis of the hope diaryThere are three questions in the hope diary, the answers to each question were refined theme as follow. Firstly, challenges and issues faced by caregivers mainly from three aspects, the caregiver themselves, their families and the economic situation. Secondly, their hope mainly from patients, social support, economic status, the caregiver themselves and their spirit. Thirdly, the patients, caregiver themselves, social support, economic status and medical technology can bring hope for caregivers.Conclusion:1.The hope of hospitalized family caregivers of patients with advanced cancer were medium to high level, but generally poor QOL.2.There were many factors affected the hope level of family caregivers of patients with advanced cancer, positive impact on QOL and the hope level can be adjusted through social support.3.LWHP has certain feasibility and effectiveness, it can effectively improve the hope level, self-efficacy and mental health of family caregivers of patients with advanced lung cancer and can effectively reduce their anxiety and depression.4.Caring for patients was the most difficult problems and challenges of family caregivers of patients with advanced lung cancer in gaining hope. There were many aspects affected their hope level, the social support can best bring life to their sense of hope. |
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