Needs Of Primary Caregivers Of Patients With Advanced Liver Cancer And Its Influence Factors

Objective: This study aimed to explore the formulation of the CNQ-PAC questionnaire in the family caregivers of advanced cancer patients and evaluate its reliability and validity, to investigate the demands of family members of terminal cancer inpatients and to explore the related influential factors to lay foundation for further intervention.Methods: 1. From August 2013 to January 2014, totally 200 family members of terminal cancer inpatients and patients from a general hospital of xi'an were investigated by convenience sampling using self-designed general characteristic questionnaire?and CNQ-PAC to confirm its reliability and validity. 2. From February 2014 to October 2014, totally 220 family members of terminal cancer inpatients and patients from a general hospital of xi'an were investigated by convenience sampling using self-designed general characteristic questionnaire?KPS?MDASI-C?TSM-PLC?HADS?CNQ-PAC.3. All data was entry in Epidata 3.0 and analyzed by using statistical package SPSS 17.0 software. All analyses were two-sided, and P < 0.05 were considered statistically significant. Statistical methods: descriptive statistics, evaluation of reliability and validity, Mann-Whitney rank sum test,multiple regression analysis, exploratory factor analysis,Results: 1. The questionnaire is scientific and feasible based on this survey in the needs of primary caregivers of advanced liver cancer patients, and can be used to investigate caregivers' needs. The general Cronbach's ? coefficient of this questionnaire was 0.93, and those of each dimension ranged from 0.79 to 0.93. The test-retest reliability coefficient was 0.91, and those of each dimension ranged from 0.64 to 0.93. The split-half reliability coefficient was 0.70 for the total score and 0.63-0.91 for each dimension. The KMO is 0.857, and the cumulative variance contribution rate of the extracted seven common factors is 69.413%. Seven common factors are extracted from the original scale.Statistical analysis showed that the correlations of the scores between each item and the total scale were ranged from 0.336-0.704, which is similar with the original scale. 2. The needs of main caregivers in advanced liver patients 2.1 The average needs score in primary caregivers of advanced hepatic cancer patients is 3.65�0.73, the overall level of needs is between �need a little�and�need a lot�. 2.2 The top three needs of seven dimensions in caregivers of advanced liver cancer is disease knowledge needs(4.53�0.78)?healthcare related behaviors needs(4.43�0.64) and patients' symptom management(3.88�1.18), while the funeral support needs rank lowest(2.94�1.12).Of note, the male caregivers' needs for knowledge of the disease was significantly higher than female caregivers; caregivers aged more than 66 years old showed the highest symptomatic control of needs; caregivers who finished junior high or below had highest demand for funeral support; Caregivers without job had higher needs in healthcare related behaviors than those with jobs; caregivers who had a similar care experience, their symptom control, psychosocial support needs of patients and total needs were significantly higher than those without similar experiences; psychological support in caregivers living with patients were significantly higher than those not live with patients together; caregivers of patients with KPS?80 had higher needs for knowledge of disease and healthcare related behaviors than those of patients with KPS?40. 2.3 The unmet rates in 12 items is higher than 90% of the whole 36 items in the questionnaire. The highest unmet rates is the item�Medical staff have experience of dealing with similar diseases�(97.3%),while the lowest unmet rates is the item�Have the chance to participate in corpse care(42.2%)�. 3. Factors influencing the needs of main caregivers in advanced liver patients 3.1 Single factor analysis 3.1.1 The influence of the main characteristics of caregivers on demands Care experience affects general needs, symptom control needs and patients' psychological support needs; caregiver gender impacts their disease knowledge needs; symptoms control needs are influenced by caregivers' age; Level of education affects funeral support needs; the employment situation affects health care-related behavioral needs; patients living with patients or not affects their psychological support needs(P <0.05). 3.1.2 The influence of the main characteristics of patients on demands Score of patients' KPS affects caregivers' disease knowledge needs and health care-related behavioral needs; patients' anxiety impacts caregivers' disease knowledge needs; patients' depression impacts caregivers' psychological support needs; the number of the M.D. Anderson Symptom is the influencing factor of caregivers' symptom control needs and psychological support needs; the number of liver cancer-specific symptoms affects caregivers' disease knowledge needs? health care-related behavioral needs?symptom control needs?psychological support needs?hospice care needs and general needs; the total score of M.D. Anderson Symptom and liver cancer-specific symptoms have influence on caregivers' symptom control needs(P<0.05),and the higher the score of the symptom events, the more caregivers' symptom control needs. Caregivers' needs increased with the increasing symptom events(P<0.05). 3.2 Multivariate analysis By multivariate analysis, experience in taking care of patients, living with patients or not, the KPS score of patients, patient anxiety, the total number of liver cancer-specific symptoms and the total score of liver cancer-specific symptoms were independently associated with care needs in caregivers of patients with advanced liver cancer.Conclusion: 1. The CNQ-PAC questionnaire in this study has high reliability and validity based on the data of 200 main caregivers needs, and can be used for survey on the needs of the caregivers of advanced cancer patients. 2. The overall level of primary caregivers needs of advanced liver cancer patients is between "need a little" and "need a lot". Caregivers have strong needs on knowledge of the disease, healthcare-related behavior and strong symptom management. The unmet rate of one third of the items is more than 90%. 3. Caregivers with diverse characteristics showed different needs level. 4. Factors affecting main caregivers' needs are from two aspects : patients and caregivers. The more anxious of the patients and the higher KPS score of patients are, the higher caregivers' needs will be. The severer symptoms event is, the higher caregivers' symptom control needs are. 5. Suggestions for intervention: Hepatic cancer patients and their caregivers are recommended to be service object in hospital. Also,medical staff should strengthen related knowledge training for caregivers in nursing care inside hospital and outside hospital. To develop individualized psychological support program according to the degree of anxiety of patients with different caregivers to adjust their own moods effectively. At the same, nurses are expected to improve patienes' symptom experience, to help patients manage symptom positively, to meet caregivers' related needs and to improve professional care skills. Only in this way, can they improve quality of life in advanced liver cancer patients and their caregivers.