Lo Chris, Hales Sarah, Braun Michal, Rydall Anne C, Zimmermann Camilla, Rodin Gary
Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Department of Psychiatry, University of Toronto, Toronto, Canada.
Psychooncology. 2013 Oct;22(10):2283-90. doi: 10.1002/pon.3289. Epub 2013 Apr 29.
The relational impact of advanced cancer on both patients and spouse caregivers has rarely been examined simultaneously. This study describes a framework for understanding distress in each partner as a consequence of psychosocial characteristics, burden of disease or of caregiving, and the distress of the other person. A model focusing on the protective value of social relatedness was tested to illustrate the interdependence of patients and spouses in their mutual adaptation to disease.
A total of 278 advanced cancer patients and their spouse caregivers completed measures of psychological distress (e.g., depression), physical burden from cancer (e.g., symptom count), caregiving burden (i.e., time and task demand), and social relatedness (i.e., social support and attachment security). Structural equation modeling was used to extract latent factors associated with these constructs and to examine their interrelationships.
The model fit was adequate. Patient distress was related to disease burden (standardized path coefficient = 0.52) and patient social relatedness (-0.32). Caregiver distress was related to caregiving burden (0.21) and caregiver social relatedness (-0.51). Caregiving burden was related to patient disease burden (0.43) and caregiver social relatedness (-0.37). Reciprocal pathways between patient and caregiver distress indicated that caregiver distress was influenced by patient distress (0.30) but not vice versa (0.12).
These findings support the view that patients and caregivers constitute an interdependent relational system and interventions in this setting should take into account both interactions between patients and caregivers and the nature of their social relatedness.
晚期癌症对患者及其配偶照顾者的关系影响很少被同时研究。本研究描述了一个框架，用于理解每个伴侣因心理社会特征、疾病负担或照顾负担以及另一方的痛苦而产生的痛苦。测试了一个关注社会关系保护价值的模型，以说明患者和配偶在共同适应疾病过程中的相互依存关系。
共有278名晚期癌症患者及其配偶照顾者完成了心理痛苦（如抑郁）、癌症身体负担（如症状数量）、照顾负担（即时间和任务需求）以及社会关系（即社会支持和依恋安全感）的测量。采用结构方程模型提取与这些构念相关的潜在因素，并检验它们之间的相互关系。
模型拟合良好。患者痛苦与疾病负担（标准化路径系数 = 0.52）和患者社会关系（-0.32）相关。照顾者痛苦与照顾负担（0.21）和照顾者社会关系（-0.51）相关。照顾负担与患者疾病负担（0.43）和照顾者社会关系（-0.37）相关。患者和照顾者痛苦之间的相互路径表明照顾者痛苦受患者痛苦影响（0.30），但反之不然（0.12）。
这些发现支持了患者和照顾者构成一个相互依存的关系系统的观点，在这种情况下的干预措施应考虑患者和照顾者之间的相互作用以及他们社会关系的性质。
