National Cancer Control Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, South Korea.
Support Care Cancer. 2010 Jun;18(6):699-706. doi: 10.1007/s00520-009-0668-5. Epub 2009 May 31.
Family caregivers play an important role in caring for cancer patients, but the impact of caregivers' unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood.
We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL).
Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P < 0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR) = 7.55; 95% confidential interval (CI) 3.80-15.00), psychosocial support (aOR = 6.24; 95% CI 2.95-13.05), symptom management (aOR = 3.21; 95% CI 2.26-4.54), community support (aOR = 3.82; 95% CI 2.38-6.11), or religious support (aOR = 4.55; 95% CI 1.84-11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR = 1.21; 95% CI 1.00-1.47), psychosocial support (aOR = 1.99; 95% CI 1.37-2.88), and religious support (aOR = 1.73; 95% CI 1.08-2.78) than those of patients receiving palliative hospice care.
Caregivers' unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged.
家庭护理人员在照顾癌症患者方面发挥着重要作用，但护理人员未满足的需求对他们提供的临终关怀质量以及对其工作场所表现的影响了解较少。
我们确定了 2004 年期间在韩国 17 家医院死亡的 1662 名癌症患者的家庭护理人员。护理人员通过电话回答了一个有关在提供终末期癌症护理时未满足的需求以及这些未满足的需求如何影响他们的工作场所表现的问卷；他们还回答了《质量关怀问卷-临终关怀》（QCQ-EOL）。
与未满足需求的护理人员相比，在症状管理、经济支持或社区支持方面有未满足需求的护理人员的 QCQ-EOL 评分较低（P<0.01）。在经济支持（调整后的优势比 (aOR) = 7.55；95%置信区间 (CI) 3.80-15.00）、心理社会支持（aOR = 6.24；95% CI 2.95-13.05）、症状管理（aOR = 3.21；95% CI 2.26-4.54）、社区支持（aOR = 3.82；95% CI 2.38-6.11）或宗教支持（aOR = 4.55；95% CI 1.84-11.26）方面有未满足需求的护理人员更有可能经历工作限制。接受常规医院护理的患者的护理人员在症状管理（aOR = 1.21；95% CI 1.00-1.47）、心理社会支持（aOR = 1.99；95% CI 1.37-2.88）和宗教支持（aOR = 1.73；95% CI 1.08-2.78）方面有未满足需求的可能性高于接受姑息治疗临终关怀的患者。
护理人员未满足的需求对他们提供的临终关怀质量和工作场所表现产生负面影响。需要更多的护理人员支持投资和满足护理人员需求的公共政策，应鼓励使用临终关怀。
