预后不良癌症患者家庭照顾者的自我护理行为：因照顾者幸福感和准备程度的不同水平而存在差异。
The self-care practices of family caregivers of persons with poor prognosis cancer: differences by varying levels of caregiver well-being and preparedness.
作者信息
Dionne-Odom J Nicholas, Demark-Wahnefried Wendy, Taylor Richard A, Rocque Gabrielle B, Azuero Andres, Acemgil Aras, Martin Michelle Y, Astin Meka, Ejem Deborah, Kvale Elizabeth, Heaton Karen, Pisu Maria, Partridge Edward E, Bakitas Marie A
机构信息
School of Nursing, University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA.
Department of Nutrition Sciences, UAB, 1675 University Blvd, Birmingham, AL, 35233, USA.
出版信息
Support Care Cancer. 2017 Aug;25(8):2437-2444. doi: 10.1007/s00520-017-3650-7. Epub 2017 Mar 1.
PURPOSE
Little is known about the impact of family caregiving for adults with poor prognosis cancer on caregivers' own individual self-care practices. We explored differences in caregivers' discrete self-care practices associated with varying levels of caregiver well-being, preparedness, and decision-making self-efficacy.
METHODS
Cross-sectional survey within eight community-based southeastern U.S. cancer centers was conducted. Family caregivers of Medicare beneficiaries ≥65 years with pancreatic, lung, brain, ovarian, head and neck, hematologic, or stage IV cancer completed measures of individual self-care practices (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and sleep), well-being (anxiety, depression, and health-related quality of life [HRQoL]), preparedness, and decision-making self-efficacy.
RESULTS
Caregivers (n = 294) averaged 66 years, were mostly female (72.8%), white (91.2%), Protestant (76.2%), retired (54.4%), and patients' spouse/partner (60.2%). Approximately, half were rural-dwellers (46.9%) with incomes <$50,000 (53.8%). Most provided support 6-7 days/week (71%) for >1 year (68%). Nearly a quarter (23%) reported high depression and 34% reported borderline or high anxiety. Low engagement in all self-care practices was associated with worse caregiver anxiety, depression, and mental HRQoL (all p values < .05). Caregivers with lower health responsibility, spiritual growth, interpersonal relation, and stress management scores had lower preparedness and decision-making self-efficacy.
CONCLUSIONS
A significant proportion of caregivers simultaneously report low engagement in all forms of self-care practices, high depression and anxiety, and low HRQoL mental health scores. Caregiver well-being, preparedness, and decision-making self-efficacy might be optimized through interventions targeted at enhancing health responsibility, stress management, interpersonal relationships, and spiritual growth self-care practices.
目的
关于家庭照顾预后不良的成年癌症患者对照顾者自身个体自我护理行为的影响，人们了解甚少。我们探讨了与照顾者不同程度的幸福感、准备情况和决策自我效能相关的离散自我护理行为差异。
方法
在美国东南部八个社区癌症中心进行了横断面调查。年龄≥65岁的医疗保险受益人的家庭照顾者，他们所照顾的患者患有胰腺癌、肺癌、脑癌、卵巢癌、头颈癌、血液系统癌症或IV期癌症，完成了个体自我护理行为（健康责任、身体活动、营养、精神成长、人际关系、压力管理和睡眠）、幸福感（焦虑、抑郁和健康相关生活质量[HRQoL]）、准备情况和决策自我效能的测量。
结果
照顾者（n = 294）平均年龄66岁，大多数为女性（72.8%）、白人（91.2%）、新教徒（76.2%）、退休人员（54.4%），是患者的配偶/伴侣（60.2%）。大约一半是农村居民（46.9%），收入低于5万美元（53.8%）。大多数人每周提供支持6 - 7天（71%），持续时间超过1年（68%）。近四分之一（23%）报告有高度抑郁，34%报告有临界或高度焦虑。所有自我护理行为参与度低与照顾者更严重的焦虑、抑郁和心理健康HRQoL相关（所有p值<0.05）。健康责任、精神成长、人际关系和压力管理得分较低的照顾者准备情况和决策自我效能较低。
结论
相当一部分照顾者同时报告在所有形式的自我护理行为中参与度低、高度抑郁和焦虑以及较低的HRQoL心理健康得分。通过针对增强健康责任、压力管理、人际关系和精神成长自我护理行为的干预措施，可能会优化照顾者的幸福感、准备情况和决策自我效能。
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