Assessment Of Burden In Osteosarcoma Patients' Caregiver And The Related Factors Analysis

Osteosarcoma is a kind of malignant tumor stems from bone, 75% of which occurs between the age of 10 and 30. The incidence of osteosarcoma is 2-3 per million, and metaphysic of long bone is the main location of tumor. Although the incidence is not high in comparison with other common malignant tumors, it occurs more often in the bone formation period of teenagers, and no typical symptom in the earlier phase, which makes it easily to be misdiagnosed as trauma. While osteosarcoma is high in malignancy and lung metastasis at early phase, the harm is tremendous and the mortality is high. To raise the survival rate, different field of research have being done, including diagnosis, treatment, nursing and so on. In the nursing aspect, the focus is on improving patients' quality of life, such as how to offer mental nursing to patient experienced amputated extremity. There was a big step in treatment research, that is the neoadjuvant chemotherapy of 1980s has elevated the five year survival rate to 80%, which prolongs a large number of patients' life time. Although it is important to pay close attention the osteosarcoma and patients, another group should not beneglected, that is the caregivers of patients. Since caregivers accompany patients through all phases, they undergo severe burden in the process, either physical or psychological. Whether caregivers stay in the good status, not only relate to their own health, but also correlate with the care quality they offer to patients, which definitely influence patients' treatment and recovery. Paying close attention to the burden of caregiver, and analyzing its related factors and affecting extent, and finally looking for suitable support measure to help them are our sense to conduct this research, which is also the demonstration of the current concept of nursing- "Health-centred" .Objectives:To evaluate the feasibility of the "Caregiver Reaction Assessment" in assessment of the burden in caregivers of osteosarcoma. Investigate the emotional state of caregivers by CESD. Discuss the effect of some demographic characteristics, care contents, patients' state on the caregivers' burden and emotional state, and the relationship between burden and depression extent. Meantime, two typical caregivers were selected for deep interview, which aims to understand the stressor and reaction at different phases further, anticipating to offer theory evidence to domestic research on cancer caregiver and application of suitable supporting measure.Methods1 46 caregivers of osteosarcoma were investigated, whose relatives were admitted in the department of orthopaedics and chemotherapy from July,2006 to March,2007 in the 2nd affiliated hospital, college of medicine, zhejiang university. Another 4 caregivers are investigated by the mail, whose relatives are in the period of follow-up. CRA(caregiver reaction assessment )was developed by Barbra Given et al in Michagan University, which is used to assess osteosarcoma caregivers' recent burden,including health problem(HP),financial problem(FP),Disrupted Schedule(DS), Lack of family support(FS) and self-esteem (SE) . SE is the positive effect from the caregiving, while other four aspects are negative side. Caregivers must be the main carers of patients. The time for care is ranged from less than 3 months to more than 1 year. CESD was used to assess the emotional state of caregivers. By comparing the scores of each dimension of CRA in different caregivers and multiple regression( stepwise method), find out the main factors influencing the variation of different dimension. Multiple regression was also conducted to analyze the factors of depression. The relationship between burden and depression was also analyzed. 2 Two caregivers of osteoarcoma, who have typical experience of caregiving ,were interviewed individually. The whole interview was recorded with consent. Main topics were extracted through repeated reading and analyzing.ResultsCRA showed good internal consistency (Cronbach α was ranged from 0.60 to 0.82), split-half reliability is 0.736. After varimax rotation, factor analysis demonstrated that eigenvalues of former 5 factors are above 2, their sums of squared loadings are 56.10%, consistent with the theory model in general. 68% caregivers in the study probably have depression, while 56% must have depression. Compare dimension score in different groups, SE differed in different ages, education level and relationship; HP showed significant difference among different careers; caregivers from different places have different extent of feeling being disrupted; in FP dimension, caregivers with different family annual income, living place ,career have different burden of finance; as to the family support, different relationship with patients, different education and career, caregivers may get different extent of family support. Demographic characteristic and the number of care activities were taken into the regression model of different dimension respectively, and 25 factors were detected to be factors influencing different dimensions. Among them, DS and FPdimension have more factors, 8 and 10 respectively, while only 1 factor affecting HP dimension, which is care time. From the angle of total analysis, caregivers' education level, whether work currently, patients' age, patients' marriage status, relationship, living place, career are main factors, which influence more than one dimension to different extent. The multiple regression of depression showed that the more care tasks, the more depressive of caregivers; male patients, come from countryside, not living with patients are three factors aggravating depression; while have someone to be assistant during care and family annual income more than 50,000 are two protecting factors in alleviating caregivers depression. In analysis of relationship between burden and depression, DS and FP dimension are positively correlated with depression.From the deep interview, caregivers do experience more negative emotion in the initial diagnosis stage, including denial, dread, despair; during the long time of care, caregivers undertake the five dimensions of burden in CRA, in addition, they have the burden in the therapy decision, the lack of social support and take care other family members;Conclusion1 CRA showed good reliability and validity in the assessment of burden in caregivers of osteosarcoma patients, it can represent the burden of caregivers from five dimensions, SE from positive side, HP, DS, FP, FS from negative side. More samples from different cancer caregivers in further research can lead to more reliable conclusion;2 The problems of finance and disrupted schedule are more evident in caregivers of osteosarcoma patients; though less burden in health problem and family support, it do exist; caregivers got high score in the self-esteem dimension, indicating a lot positive effect have been obtained through care. Factors influencing dimensionscores are caregivers' age, education level, marriage, care time; patients' marriage, living place, the number of care tasks;3 Caregivers of osteosarcoma patients have severe depression problem, more than 50% of caregivers reach the diagnosis level. Factors related to depression level including family economic status, come from city or country, patients' gender, the number of care tasks, whether has someone to help in care, whether live with patients;4 From the deep interview, at the initial diagnosis stage, caregivers need to be supplied with more emotion and information support; in the long term, they need financial support to relieve their economy burden, someone to help take care of patients to release them for some time, more family and social support to be their mental support.