Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Palliat Support Care. 2011 Sep;9(3):315-25. doi: 10.1017/S1478951511000265.
Because caregiving to an adult with cancer is a dynamic process, a caregiver's perceived burden and psychosocial concerns may be different at different phases of the patient's disease. There is evidence of escalation in caregiver anxiety, depression, and psychological distress as the patient's functional status declines and as the patient nears death. The purpose of this review was to organize the literature in a meaningful way that can potentially capture the unique needs of caregivers to patients receiving palliative and/or hospice care, and caregivers who are in the post-death bereavement phase.
A systematic review was conducted. Major databases were searched for non-intervention descriptive studies that included psychosocial variables of family caregivers to adults with cancer during the palliative, hospice, or bereavement phases.
The 19 studies reviewed were conducted in six countries and varied considerably by samples, outcome measures, methodologies, and analytic approaches. Despite limiting to the palliative, hospice, and bereavement phases, inconsistent results were found for key variables, such as age, gender, and relationship to the patient. When patient-caregiver dyad analysis was conducted, with rare exception, there was mutuality between the patient's condition and the caregiver's response. Across the 19 studies, 89 unique instruments were used, almost half of which were study specific with no psychometric testing reported. CONCLUSIONS/SIGNIFICANCE OF RESEARCH: As a direct consequence of assuming the caregiver role, cancer family caregivers in the palliative, hospice, and bereavement phases are at increased risk for physical and mental morbidity. Often, the psychological burden of the caregiver exceeds that of the critically ill patient. It is possible that distressed caregivers have a deleterious influence on patient well-being. This review demonstrates the need to develop research standards, especially regarding measurement instruments, so that caregiver research can mature and interventions can be developed to support family caregivers.
由于照顾癌症成人是一个动态的过程，照顾者的感知负担和心理社会问题在患者疾病的不同阶段可能会有所不同。有证据表明，随着患者功能状态的下降和接近死亡，照顾者的焦虑、抑郁和心理困扰会加剧。本综述的目的是将文献以一种有意义的方式组织起来，以便能够捕捉到接受姑息治疗和/或临终关怀的患者的照顾者和处于丧亲后哀悼阶段的照顾者的独特需求。
进行了系统评价。主要数据库被搜索，以查找包括姑息治疗、临终关怀或丧亲后阶段癌症成年患者的家庭照顾者的心理社会变量的非干预描述性研究。
共综述了 19 项研究，这些研究分别在六个国家进行，样本、结果测量、方法和分析方法差异很大。尽管限制在姑息治疗、临终关怀和丧亲后阶段，但关键变量（如年龄、性别和与患者的关系）的结果不一致。当对患者-照顾者对子进行分析时，除了极少数例外，患者的病情和照顾者的反应是相互的。在这 19 项研究中，共使用了 89 种独特的工具，其中近一半是特定于研究的，没有报告心理测量学测试。
结论/研究意义：作为承担照顾者角色的直接后果，处于姑息治疗、临终关怀和丧亲后阶段的癌症家庭照顾者面临着身体和精神疾病的风险增加。通常，照顾者的心理负担超过重病患者。照顾者的痛苦情绪有可能对患者的幸福感产生不利影响。本综述表明需要制定研究标准，特别是关于测量工具，以便照顾者研究能够成熟，并能够开发干预措施来支持家庭照顾者。
