Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire 03755, USA.
Palliat Support Care. 2010 Dec;8(4):395-404. doi: 10.1017/S1478951510000258. Epub 2010 Sep 28.
Caregivers of patients with advanced cancer experience physical and emotional strain that can raise their own risk for morbidity and mortality. This analysis was performed to determine whether ENABLE II, a patient-focused palliative care intervention that increased patients' quality of life, reduced symptom intensity, and lowered depressed mood compared to usual care, would affect caregiver burden.
Caregivers of patients with advanced cancer from the parent study completed a caregiver burden scale and patients completed quality of life, symptom intensity, and depressed mood measures. Data were collected at baseline, 1 month, and every 3 months thereafter until patient death or the study ended. Decedents' caregivers were asked to complete an after-death interview regarding the quality of care that the patient received.
There were no significant differences in caregiver burden between intervention and usual care conditions. Follow-up analyses showed that higher caregiver objective burden and stress burden were related to lower patient quality of life, higher symptom intensity, and higher depressed mood. Caregivers who perceived that patients had unmet needs at end of life reported higher objective burden, and those who perceived that patients were not treated with respect reported higher demand burden.
The results indicate that a successful patient-focused intervention did not have a similar beneficial effect on caregiver burden. Future interventions should focus on caregivers as well as patients, with particular attention to caregivers' perceptions of patient care, and seek to change both negative and positive effects of informal caregiving.
晚期癌症患者的护理人员会经历身体和情绪上的压力，这可能会增加他们患病和死亡的风险。本分析旨在确定 ENABLE II 能否对护理人员的负担产生影响，这是一种以患者为中心的姑息治疗干预措施，与常规护理相比，它可以提高患者的生活质量，减轻症状强度，降低抑郁情绪。
来自母研究的晚期癌症患者的护理人员完成了一项护理人员负担量表，患者则完成了生活质量、症状强度和抑郁情绪的测量。数据在基线、1 个月和此后每 3 个月收集，直到患者死亡或研究结束。死者的护理人员被要求在死后对患者接受的护理质量进行访谈。
干预组和常规护理组之间的护理人员负担没有显著差异。随访分析表明，护理人员的客观负担和压力负担较高与患者生活质量较低、症状强度较高和抑郁情绪较高有关。护理人员认为患者在生命末期有未满足的需求时，报告的客观负担较高，而认为患者没有受到尊重的需求负担较高。
研究结果表明，一项成功的以患者为中心的干预措施对护理人员的负担并没有类似的有益影响。未来的干预措施应该同时关注患者和护理人员，特别注意护理人员对患者护理的看法，并寻求改变非正式护理的消极和积极影响。
