Status Of Caregiver Burden In Parents Of Children With Malignant Solid Tumor And Its Relationship With Adult Attachment Style And Communication Pattern

Objectives:To investigate the current status of caregiving burden among parents of children with malignant solid tumors,explore the relationship between caregiving burden and attachment style,communication patterns,and further analyze the mediating effect of communication patterns on the relationship between parental attachment style and caregiving burden.The study aims to provide empirical evidence for relieving caregiving burden among parents of children with malignant solid tumors.Methods:A convenient sampling method was used to recruit 264 parents of children with malignant tumors from a tertiary grade A cancer specialist hospital in Jinan,Shandong Province,from September 2021 to September 2022.A general information questionnaire,Caregiver Burden Inventory(CBI),Adult Attachment Questionnaire Short Form(AAQ-SF)and Communication Pattern Questionnaire(CPQ)were used for data collection.SPSS version 27.0 and SPSS macro program PROCESS 4.1 were used for statistical analysis.The main methods included independent sample t test,one-way ANOVA,Pearson correlation analysis,hierarchical linear regression and mediation effect test.Results:1.The status and difference analysis of caregiver burden in parents of children with malignant solid tumorThe average score of caregiver burden in 264 parents of children with malignant solid tumor included in this study was(43.77±11.31),with the highest score dimension being time-dependent burden(2.85±0.79)and the lowest dimension being affective burden(0.64±0.65).According to the truncation value of the scale,81.1%of the parents of children with malignant solid tumors had moderate caregiver burden.Univariate analysis showed that the score of caregiver burden was statistically correlated with whether the child was in school(t=2.038,P=0.043),the treatment received(F=7.953,P<0.001),the course of illness(t=2.019,P=0.045),whether the treatment was fully self-funded(t=2.052,P=0.041),parental status(t=2.449,P=0.015),parents’ current occupational status(F=4.555,P=0.011),and role division(t=2.164,P=0.031).2.Correlation analysis of attachment style,communication pattern and caregiver burden in parents of children with malignant solid tumorIn this study,the average score of attachment anxiety of 264 parents of children with malignant solid tumors was(15.67±5.75);the average score of attachment avoidance was(15.14±5.95);the average scores of constructive communication,demand/avoidance communication,and mutual avoidance communication were(11.75±8.27),(12.76±8.33)and(7.53±4.37),respectively.The results of correlation analysis showed that parents’ attachment avoidance(r=0.328),attachment anxiety(r=0.212),demand/avoidance communication(r=0.371),mutual avoidance communication(r=0.316)were positively correlated with caregiver burden(all P<0.01).The score of constructive communication was negatively correlated with caregiver burden(r=-0.367,P<0.01).Attachment anxiety and attachment avoidance were significantly negatively correlated with constructive communication(r=-0.252,-0.365,all P<0.01),and were significantly positively correlated with demand/avoidance communication(r=0.203,0.290,all P<0.01)and mutual avoidance communication(r=0.189,0.258,all P<0.01).3.Hierarchical linear regression analysis of caregiver burden in parents of children with malignant solid tumorTaking the total score of caregiver burden in parents of children with malignant solid tumor as the dependent variable,two regression models were constructed by placing statistically significant general data from univariate analysis into the first layer,parental attachment anxiety and attachment avoidance respectively into the second layer,and communication pattern into the third layer.The results of the first regression model showed that attachment anxiety and demand/avoidance communication were significantly positive predictors of caregiver burden(β=0.196,0.197,both P<0.05),and constructive communication was significantly negative predictors of caregiver burden(β=-0.182,P<0.01).The results of the second regression model showed that attachment avoidance and demand/avoidance communication were significantly positive predictors of caregiver burden(β=0.287,0.188,both P<0.05),and constructive communication was significantly negative predictors of caregiver burden(β=-0.156,P<0.05).4.The mediating effect of communication pattern on attachment style and caregiver burden in parents of children with malignant solid tumorBased on the results of hierarchical linear regression,PROCESS 4.1 was used to test the mediating effect,and the results showed that attachment anxiety could indirectly affect parents’ caregiver burden through constructive communication(95%CI=0.015～0.087)and demand/avoidance communication(95%CI=0.013～0.075).The indirect effects were 0.046 and 0.041,accounting for 22.89%and 19.98%of the total effect,respectively.Attachment avoidance also could indirectly affect parents’ caregiver burden through constructive communication(95%CI=0.015～0.087)and demand/avoidance communication(95%CI=0.013～0.075).The indirect effects were both 0.058,accounting for 19.50%of the total effect.Conclusions:1.Parents of children with malignant solid tumor generally have moderate caregiver burden,which is worthy of attention.2.Attachment style,constructive communication and demand/avoidant communication patterns of parents of children with malignant solid tumor were significant predictors of caregiver burden in parents of children with malignant solid tumors.3.Both attachment anxiety and attachment avoidance of parents of children with malignant solid tumors can indirectly affect their caregiver burden through demand/avoidance communication and constructive communication.This result provides empirical research support for improving the caregiver burden of parents with malignant solid tumors.