The Anticipatory Grief And Its Influencing Factors Among Primary Caregivers Of Hospitalized Patients With Advanced Lung Cancer

Objectives:Current study aims to investigate the anticipatory grief of the primary caregivers of hospitalized patients with advanced lung cancer,and to explore their influencing factors based on the integrative risk factor framework for the prediction of bereavement outcome,which could provide empirical research support for clinical doctors and nurses to intervene and alleviate the degree of anticipatory grief of the primary caregivers.Methods:From June 2019 to January 2020,a questionnaire survey was conducted among the primary caregivers of 350 inpatients with advanced lung cancer who met the inclusion criteria in three Grade 3A hospitals in Shandong Province.The survey tools included general information questionnaire,Anticipatory Grief Scale(AGS),Caregiver burden inventory(CBI),neuroticism,extraversion and conscientiousness subscales of the Big-Five Factor Inventory(BFI),Perceived Social support Scale(PSSS)and Simplified Coping Style Questionnaire(SCSQ).Data were analyzed by SPSS 23.0 and Amos 22.0 statistical analysis software.Statistical methods included:descriptive analysis,Independent Sample T-test,One-way Analysis of Variance,Pearson and Spearman correlation analysis,Hierarchical Linear Regression,Path Analysis.Results:1.Data collectionIn this study,a total of 350 questionnaires were sent out,13 invalid questionnaires were excluded,337 valid questionnaires were received,and the response rate of valid questionnaires was 96.29%2.The anticipatory grief of the primary caregivers among hospitalized patients with advanced lung cancer.The total score of anticipatory grief among the primary caregivers of inpatients with advanced lung cancer was 78.01±18.59.The average scores of items in each dimension were as follows:feeling of loss(3.91±0.77),sadness(3.09±0.93),anxiety(2.68±0.94),anger(2.68±0.88),ability to complete tasks(2.66±0.99),guilt(2.58±0.74)and irritability(2.25±0.80).3.The results of univariate analysis of anticipatory grief among the primary caregivers of hospitalized patients with advanced lung cancer.The anticipatory grief scores were different across the primary caregiver's different education level,place of residence,physical status,working status,family economic status,relationship with patients,alternative caregivers,knowledge of lung cancer and received death education(p<0.01).The anticipatory grief scores were different in patient's different work status,education level and type of medical insurance(p<0.05).The caregiver's age(r=0.127,p<0.05),caring hours per day(r=0.149,p<0.01),caring burden(r=0.623,p<0.001),neuroticism(r=0.380,p<0.001)and negative coping(r=0.239,p<0.001)were positively correlated with anticipatory grief.There was a negative correlation between anticipatory grief and the age of the patients(r=-0.147,p<0.01),extroversion(r=-0.167,p<0.01),conscientiousness(r=-0.141,p<0.01),perceived social support(r=-0.121,p<0.05)and active coping(r=-0.113,p<0.05)4.The results of multivariate analysis of anticipatory grief among the primary caregivers of hospitalized patients with advanced lung cancer.The nature of stressors,personal factors,interpersonal factors and coping styles explained 40.4%,9.1%,5.1%and 0.6%of the variance in anticipatory grief,respectively.All variables explained 55.2%of the variance.Physiological burden(p = 0.170,p<0.05),time-dependent burden(?=0,129,p<0.05),limited development burden(?=0.179,p<0.01),neuroticism(?=0.264,p<0.001),death education(?=-0.107,p<0.05),family support(?=0.265,p<0.001)and other support(?=-0.200,p<0.01)predicted the anticipatory grief of the primary caregivers.5.The results of path analysis of the main influencing factors of anticipatory grief among the primary caregivers of hospitalized patients with advanced lung cancerNeuroticism,care burden and perceived social support were the main influencing factors of anticipatory grief.The results of path analysis showed that neuroticism significantly directly increased care burden(?=0.16,p<0.01),decreased perceived social support(?=-0.15,p<0.01),and increased anticipatory grief(?=0.28,p<0.01).Care burden significantly increased anticipatory grief((?=0.57,p<0.01),and perceived social support significantly reduced care burden(?=-0.14,p<0.01).Care burden and perceived social support mediated the relationship between neuroticism and anticipatory grief.The direct effects of neuroticism and care burden on anticipatory grief were 0.275(95%CI:0.178,0.356)and 0.573(95%CI:0.494,0.645),respectively;the indirect effects of neuroticism,perceived social support on anticipatory grief were 0.105(95%CI:0.047,0.166)and-0.082(95%CI:-0.138,-0.026),respectively.Conclusion:1.The primary caregivers of hospitalized patients with advanced lung cancer had moderate anticipatory grief.2.Based on the integrative risk factor framework for the prediction of bereavement outcome,physiological burden,time-dependent burden,limited development burden in the nature of stressors,neuroticism in personal factors,family support among interpersonal factors were risk factors for anticipatory grief of the primary caregivers of hospitalized patients with advanced lung cancer,while death education and other support among interpersonal factors were protective factors.3.Care burden and perceived social support mediated the relationship between neuroticism and anticipatory grief among the primary caregivers of hospitalized patients with advanced lung cancer.