A Longitudinal Study Of The Effect Of Sense Of Coherence On Caregiver Burden Among Primary Caregivers Of Postoperative Chemotherapy Patients With Colorectal Cancer

[Objective]Objective to clarify the predictive role of sense of coherence of primary caregivers of postoperative chemotherapy patients with colorectal cancer on the trend of caregiver burden,and to describe the characteristics of caregivers with heavy caregiver burden,so as to provide reference for the development of targeted intervention strategies.[Methods]Using the longitudinal study design,from November 2021 to November 2022,a questionnaire survey was conducted in the oncology department of three tertiary hospitals in Suzhou,and 204 pairs of colorectal cancer patients and their primary caregivers who met the criteria for postoperative chemotherapy were surveyed.The time points of the investigation were:before the first chemotherapy,after the first chemotherapy,after the interim chemotherapy,and after the last chemotherapy.The tools of the survey included:the patient’s general information questionnaire,the primary caregiver general information questionnaire,Sense of coherence(SOC)and Zarit Caregiver Burden Interview(ZBI).Repeated measures variance analysis were used to describe the trajectory of primary caregiver care burden in the postoperative chemotherapy period of colorectal cancer patients;the growth mix modeling(GMM)was used to fit the potential categories of care burden development trajectory of primary caregivers;logistic regression was used to analyze the predictive effect of sense of coherence on the trajectory of care burden.[Results]1.Trajectories of primary caregiver care burden in colorectal cancer patients undergoing postoperative chemotherapy(1)The primary caregiver of patients during chemotherapy after colorectal cancer surgery continues to have varying degrees of care burden.The overall change trend of care burden at different stages of chemotherapy increased first and then decreased.The burden of care was highest after the first chemotherapy(T2:49.36±15.17)and the lightest after the last chemotherapy(T4:40.31±13.49),which was lower than before the first chemotherapy after surgery(T1:43.47±15.13).(2)The growth mix modeling was used to divide the care burden of primary caregivers into four latent categories,namely no care burden group(12.9%),light care burden group(22.0%),moderate care burden group(46.6%),and heavy care burden group(18.6%).The change trend of care burden in all four groups increased first and then decreased.The burden of care was highest after the first chemotherapy(T2)and the lightest after the last chemotherapy(T4),which was lower than before the first chemotherapy after surgery(T1).Among them,the heavy care burden group had the largest change in care burden.2.Analysis of influencing factors of potential categories of the change trajectory of the main caregiver of colorectal cancer patients during the postoperative chemotherapy stageThe potential categories of the trajectory were primary caregivers in the moderate-heavy care burden group had lower education level(secondary school level and below),had chronic diseases,or had longer average daily care hours(≥8 hours)than primary caregivers in the no and light care burden groups.In addition,there are no alternative caregivers,the primary caregiver of the patient with one child,or the primary caregiver of the patient with a stoma after surgery is more likely to develop into the heavy care burden group.3.The level of sense of coherence of the primary caregivers of postoperative chemotherapy patients with colorectal cancerThe total score of sense of coherence of primary caregivers of postoperative chemotherapy patients with colorectal cancer was(65.52±14.75),which was generally at a moderate-low level.The scores of the three dimensions of sense of coherence from high to low are comprehensibility(25.46±5.95),meaningfulness(20.27±4.72)and manageability(19.79±5.36).4.The predictive effect of sense of coherence of primary caregivers of colorectal cancer patients during postoperative chemotherapy on the trajectory of care burdenCompared with the no care burden group,the potential categories of the primary caregivers with moderate sense of coherence were mostly in the moderate care burden group(Score of 64～79 points).The potential categories of the primary caregivers with low level of sense of coherence were mostly in the group of heavy care burden(Score of 13-63 points).[Conclusion]1.The primary caregivers of colorectal cancer patients in the postoperative chemotherapy stage continued to have different degrees of care burden.The trend of care burden in the four potential category groups at different stages of chemotherapy increased first and then decreased.The level of burden of care is highest after the first chemotherapy(T2)and lower after the last chemotherapy(T4)than before the first chemotherapy(T1).Therefore,clinical staff need to formulate a reasonable and targeted primary caregiver support plan based on the patient’s care burden and specific chemotherapy stage.Focus on the primary caregiver groups in the moderate-to-heavy care burden group and patients in the first post-chemotherapy stage of chemotherapy.2.Primary caregivers with low education level(secondary school level and below),chronic diseases,and a longer average daily care time(≥8 hours)tend to have a moderate to severe care burden.There are no alternative caregivers,the primary caregiver of the patient with one child,or the primary caregiver of the patient with a stoma after surgery is more likely to develop into the heavy care burden.Therefore,clinical staff need to provide targeted support according to the individual characteristics of colorectal cancer patients and their primary caregivers during postoperative chemotherapy to alleviate their care burden.3.Sense of coherence is a predictor of care burden,and higher levels of sense of coherence may be associated with lower levels of care burden.Therefore,clinical medical personnel should focus on primary caregivers with a low to moderate level of sense of coherence and provide targeted support and psychological counseling.