Given Barbara, Wyatt Gwen, Given Charles, Sherwood Paula, Gift Audrey, DeVoss Danielle, Rahbar Mohammad
College of Nursing, Michigan State University in East Lansing, USA.
Oncol Nurs Forum. 2004 Nov 16;31(6):1105-17. doi: 10.1188/04.ONF.1105-1117.
PURPOSE/OBJECTIVES: To examine the patient and family caregiver variables that predicted caregiver burden and depression for family caregivers of patients with cancer at the end of life.
A prospective, longitudinal study was implemented with an inception cohort of patients and their family caregivers who were followed after the diagnosis and treatment of cancer.
Community oncology sites in the midwestern United States.
152 family caregivers of patients with cancer who died during the course of the study.
Telephone interviews were conducted with patients at 6-8, 12-16, 24-30, and 52 weeks following diagnoses. In addition, patient medical records and state death certificates were reviewed.
Effect of caregiver age, gender, education, relationship to the patient, employment status, reports of patient symptoms, patient cancer type, stage of cancer, time from the patient's diagnosis to death, caregiver burden, and depression.
Caregivers aged 45-54 reported the highest levels of depressive symptoms, and caregivers aged 35-44 reported the strongest sense of abandonment. Caregivers who were the adult children of patients with cancer and those who were employed reported high levels of depressive symptoms. Feeling abandoned (a portion of caregiver burden) was more prevalent in female, nonspouse, and adult children caregivers, and adult children caregivers of patients with early-stage cancer and patients with multiple symptoms reported a high perception of disruption in their schedule because of providing care. Caregivers whose patients died early following diagnosis reported the highest depressive symptoms, burden, and impact on schedule.
Caregivers reported levels of depression at thresholds for screening of clinical depression. The number of patient symptoms was related to levels of caregiver depressive symptoms. An association also was found between depression and employment status. Caregiver distress was not dependent on demands of care.
Very little research exists that prospectively analyzes family caregiver experiences of burden and depression when providing end-of-life cancer care for a family member. Interventions aimed at decreasing caregiver depressive symptoms should be targeted to caregivers who are middle-aged, adult children, and employed. Interventions aimed at decreasing the burden associated with feeling abandoned and having schedules disrupted while providing care should be targeted to caregivers who are female, nonspouse, and adult children, and caregivers of patients with early-stage cancer and multiple symptoms.
目的/目标：探讨在患者生命末期，预测癌症患者家庭照顾者负担和抑郁情绪的患者及家庭照顾者相关变量。
对一组癌症患者及其家庭照顾者开展前瞻性纵向研究，自癌症诊断和治疗后开始跟踪随访。
美国中西部的社区肿瘤治疗点。
152名在研究过程中其癌症患者已死亡的家庭照顾者。
在诊断后的6 - 8周、12 - 16周、24 - 30周和52周对患者进行电话访谈。此外，查阅患者病历和国家死亡证明。
照顾者年龄、性别、教育程度、与患者的关系、就业状况、患者症状报告、患者癌症类型、癌症分期、从患者诊断到死亡的时间、照顾者负担及抑郁情绪。
45 - 54岁的照顾者报告有最高水平的抑郁症状，35 - 44岁的照顾者报告有最强的被遗弃感。癌症患者的成年子女且就业的照顾者报告有高水平的抑郁症状。女性、非配偶及成年子女照顾者中，感觉被遗弃（照顾者负担的一部分）更为普遍，癌症早期患者及有多种症状患者的成年子女照顾者报告因提供照顾而对自己的日程安排有高度的受干扰感。诊断后患者早亡的照顾者报告有最高水平的抑郁症状、负担及对日程安排的影响。
照顾者报告的抑郁水平达到临床抑郁筛查阈值。患者症状数量与照顾者抑郁症状水平相关。还发现抑郁与就业状况之间存在关联。照顾者的痛苦并不取决于护理需求。
很少有研究前瞻性地分析为家庭成员提供临终癌症护理时家庭照顾者的负担和抑郁经历。旨在减轻照顾者抑郁症状的干预措施应针对中年、成年子女且就业的照顾者。旨在减轻因提供护理时感觉被遗弃和日程安排受干扰所带来负担的干预措施应针对女性、非配偶及成年子女照顾者，以及癌症早期患者和有多种症状患者的照顾者。
