Study On The Burden Of The Primary Caregiver For Digestive System Cancer Patients And Its Intervention

ObjectTo describe the current situation of the burden of the primary caregivers for patients with digestive system cancer and to analyze their influencing factors.On this basis,combined with the stress-response theory,the intervention program to reduce the burden on the primary caregivers was developed and the effect was verified,which provided the basis for clinical practice.MethodThis study is divided into two parts:The first part is used the investigation method.From January to July in 2016,220patients with digestive system cancer and their primary caregivers were selected for the study.The research tools were used as<the questionnaire for the care of the primary caregivers of patients with digestive system cancer>,including the general questionnaire of patients and their primary caregivers,the KPS scale(percentage system,10points),the Hospital Anxiety and Depression Scale(3 dimensions,10 entries)and the Caregiver Reaction Assessment scale(5 dimensions,24 entries,using the Likert 5 grade).In the second part is used experimental research method.60 cases of the primary caregivers in the first part of the study were included in the second study,and the caregivers were randomly divided into intervention group and control group.Based on the theory of stress-assessment-response theory,combined with the results of the first part,the intervention programme was developed.The evaluation was performed at 6 weeks after discharge and 18 weeks after discharge.The evaluation of the effect was evaluated using the Caregiver Response Assessment Scale and the SF-12v2 Quality of Life Scale(12entries,using the Lickett 5 Grade)The data were recorded using Epidate 3.1and analyzed using SPSS19.0 software,including descriptive analysis,independent sample t test,variance analysis,Pearson correlation analysis,χ~2 test,Mann-Whitney U test,multivariate stepwise regression analysis,Multiple variance analysis and repeated measurement of variance analysis.ResultThe survey results of the first part:(1)the general information of patients:a total of 220 cases of digestive system cancer patients,including 55 cases of liver cancer,colorectal cancer in 66 cases,39 cases of gastric cancer,esophageal cancer in 39 cases,11 cases of pancreatic cancer;The average age was 57.32±13.22 years old.The payment method was mainly medical insurance(202cases,96.2%),and the body function status scores were 70±11.82 points.(2)The general information of the primaty caregivers:more women(124 cases,59%);the average age was46.70±13.04 years old;the relationship with the patient was the majority of the spouse(119 cases,56.7%);rural people were mostly(110 cases,accounting for 52.4%);low education were mostly(primary and below accounted for 31.0%);family income less than5000 accounted for 47.6%.(3)Anxiety and depression in patients:anxiety average score was 8.39±3.98 points,43 patients(20.5%)patients with anxiety;depression average score was 7.40±4.30 points,47 cases(22.4%)patients with depression mood.(4)Social support for primary caregivers:38.51±6.05,at a moderate level.(5)The burden of the primary caregivers:the negative feelings scores of the primary caregivers of patients with digestive system cancer were 13.89±1.12 points,of which the disturbed dimension scorescoring dimension score was 4.16±0.57 points,the economic problem dimension score was 3.70±0.78 points,and the health dimension score was 3.07±0.62 points,the family support lack of dimension score of 2.72±0.69 points;positive feelings that the self-esteem dimension is 3.92±0.44 points.(6)Correlation between anxiety,depression and burden of patients:anxiety was positively correlated with the dimensions of time disturbance and self-esteem(r=0.386,0.157,P<0.05),negative correlated with the lack of family support(r=-0.233,P<0.05).Depression was positively correlated with the disturbed dimensions(r=0.325,P<0.05),negative correlated with the lack of family support(r=-0.251,P<0.05).(7)The relationship between social support and burden of caregivers:correlated with the self-esteem dimensions(r=0.347,P<0.01),negatively correlated with the dimensions of economic problems and lack of family support(r=-0.309,-0.181,P<0.01),and there was no correlation with the dimension of disturbances.(8)Univariate analysis showed that the factors related to the burden were whether the patient was informed,whether the pain,tumor type,current treatment and KPS score,the different sex of the caregiver,year.(9)The results of multiple stepwise regression analysis showed that caregivers’social support,patient relationships,and patient physical status scores predict predictive economic problems.The patient’s anxiety,the type of tumor,and the caregiver’s daily use,household monthly income,and patient relationships predict predictable caregiver timing disturbances.The age of the patient,the type of tumor,and the daily use of the caregiver can predict the health of the caregiver.Patient’s depression,caregiver’s marital status,family monthly income,care time,and social support predict the lack of caregiver’s family support.Caregiver marital status,social support,and family monthly income can predict caregiver’s self-esteem.The predictors which can be intervened are the caregiver’s social support,taking care of the daily use,the patient’s anxiety and depression,the patient’s physical function.The second part of the intervention results:(1)The impact of the caregiver burden:6weeks after discharge,intervention intervention group’time disturbed dimension,family support lack of dimensions were significantly lower than the control group,the self-esteem dimension was significantly higher than the control(P<0.05).The four dimensions of the negative sensation in the intervention group at 18 weeks after discharge were significantly lower than those in the control group(P<0.05).The results of repeated analysis of variance analysis showed that,there was an interaction between the five dimensions(P<0.05),and the main effect of the intervention was significant(P<0.05).(2)The impact on the quality of life of the caregiver:the psychological score of the intervention group was higher than that of the control group(P<0.05)at 6 weeks and 18 weeks after discharge,there was no statistically difference in the physiology score(P>0.05).The results of repeated analysis of variance analysis showed that the main effect of psychological total score and the main effect and interaction were significant(P<0.05),while the total score was only the interaction,the main effect of time and the main effect of intervention Not significant(P>0.05).ConclusionThe main caregivers of patients with digestive system cancer are generally burdened with feelings of both negative and positive feelings.The burden of feelings is influenced by a number of factors,which can be used to predict the level of social support of the caregiver,taking care of the daily use,the patient’s anxiety and depression,and the patient’s physical function.Telephone intervention,network support,supplemented by nursing intervention can reduce the caregiver’s care load,enhance the positive feelings,and can improve the caregiver’s mental health-related quality of life.