Lee Ji Eun, Shin Dong Wook, Cho Juhee, Yang Hyung Kook, Kim So Young, Yoo Hyo Sang, Jho Hyun Jung, Shin Joo Yeon, Cho Belong, Park Keeho, Park Jong-Hyock
Department of Family Medicine/Cancer Survivorship Clinic, Seoul National University Hospital, Seoul, Korea.
Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
Psychooncology. 2015 Nov;24(11):1545-51. doi: 10.1002/pon.3827. Epub 2015 Apr 29.
Recently, caregiver burden (CB) has emerged as an important issue in the area of palliative medicine. However, patients' feelings related to being a burden to their families (i.e., self-perceived burden [SPB]) is also a significant issue. We evaluated the relation of CB and SPB as preference for palliative care.
A national, multicenter, cross-sectional survey of 326 patient-caregiver dyads was performed. A set of paired questionnaires evaluating CB and SPB (five domain items assessed on a four-point Likert scale) were independently administered to patients and their caregivers. Among the respondents, only the patients with distant stage cancer and their caregivers were included. Multivariate analyses were conducted to identify the associations between CB and SPB and preference for palliative care.
Caregivers and patients who preferred palliative care to life sustaining treatment reported higher CB and SPB scores, respectively. Caregivers who felt more of a burden were more likely to prefer palliative care over life sustaining treatment for their patients (adjusted odds ratio [aOR] = 1.67, 95% CI: 1.21-2.31). In addition, patients who perceived their caregivers' burden as large tended to prefer palliative care (aOR = 1.61, 95% CI: 1.16-2.22).
Both CB and SPB increased preference for palliative care. This could be interpreted that high CB can lead to preference for palliative care in both patients and their caregivers, potentially threatening patient autonomy. Efforts to relieve CB and SPB are needed.
近年来，照护者负担（CB）已成为姑息医学领域的一个重要问题。然而，患者对成为家人负担的感受（即自我感知负担[SPB]）也是一个重要问题。我们评估了CB和SPB与姑息治疗偏好之间的关系。
对326对患者-照护者进行了一项全国性、多中心横断面调查。一套评估CB和SPB的配对问卷（五个领域项目采用四点李克特量表评估）分别发放给患者及其照护者。在受访者中，仅纳入了晚期癌症患者及其照护者。进行多变量分析以确定CB和SPB与姑息治疗偏好之间的关联。
相较于维持生命治疗，更倾向于姑息治疗的照护者和患者分别报告了更高的CB和SPB得分。负担感更强的照护者更有可能为其患者选择姑息治疗而非维持生命治疗（调整优势比[aOR]=1.67，95%置信区间：1.21-2.31）。此外，认为其照护者负担大的患者往往更倾向于姑息治疗（aOR=1.61，95%置信区间：1.16-2.22）。
CB和SPB均增加了对姑息治疗的偏好。这可以解释为，高CB会导致患者及其照护者都倾向于姑息治疗，这可能会威胁患者的自主权。需要努力减轻CB和SPB。
