School of Nursing, Medical College, Chang Gung University, Taiwan, ROC; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC; Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, ROC.
Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, ROC; Chang Gung University College of Medicine, Taiwan, ROC.
J Pain Symptom Manage. 2021 May;61(5):974-982. doi: 10.1016/j.jpainsymman.2020.09.033. Epub 2020 Sep 28.
Preparing family caregivers for a patient's death is an integral component of quality end-of-life care, but temporal changes in emotional preparedness for death and its associations with caregivers' psychological well-being or quality of life (QOL) while providing end-of-life caregiving are under-researched. Our study was conducted to fill this gap.
For this prospective, longitudinal study, the course of changes in adequate emotional preparedness for death and its associations with severe depressive symptoms and QOL were examined on 309 consecutive caregivers of terminally ill cancer patients by univariate and multivariate generalized estimating equation analyses, respectively.
Prevalence of adequate emotional preparedness for death was 57.2%, 61.3%, 54.4%, and 46.0% at 181-365, 91-180, 31-90, and 1-30 days before the patient's death, respectively, without significant changes as the patient's death approached. Adequate emotional preparedness for death was associated with caregivers' lower likelihood of severe depressive symptoms (adjusted odds ratio [95% CI]: 0.23 [0.16, 0.32], P < 0.001) but with their better QOL (adjusted β [95% CI]: 7.65 [6.38, 8.92], P < 0.001) in the patient's last year.
Without active, effective clinical interventions to promote caregivers' emotional preparedness for death, they cannot automatically become more prepared for the patient's death over time. Adequate emotional preparedness for the patient's death benefits caregivers by its associations with a lower likelihood of depressive symptoms and better QOL. Supportive programs for caregivers of terminally ill cancer patients should focus on not only enhancing caregiving skills but also cultivating emotional preparedness for their relative's death to promote their psychological well-being and QOL.
为患者的死亡做好家属的准备是临终关怀质量的一个组成部分，但对于死亡的情绪准备程度随时间的变化，以及其与临终关怀期间照顾者的心理健康或生活质量（QOL）之间的关系，研究还不够充分。我们的研究旨在填补这一空白。
在这项前瞻性、纵向研究中，通过单变量和多变量广义估计方程分析，分别研究了 309 名临终癌症患者连续照顾者在 181-365、91-180、31-90 和 1-30 天前死亡时的适当情绪准备程度的变化及其与严重抑郁症状和 QOL 的关联。
在患者死亡前 181-365、91-180、31-90 和 1-30 天，适当的死亡情绪准备的患病率分别为 57.2%、61.3%、54.4%和 46.0%，但随着患者死亡的临近，没有明显变化。适当的死亡情绪准备与照顾者出现严重抑郁症状的可能性较低（调整后的优势比[95%置信区间]：0.23[0.16，0.32]，P<0.001），但在患者生命的最后一年，他们的 QOL 更好（调整后的β[95%置信区间]：7.65[6.38，8.92]，P<0.001）。
如果没有积极、有效的临床干预措施来促进照顾者对死亡的情绪准备，他们不会随着时间的推移自动为患者的死亡做好更充分的准备。适当的患者死亡情绪准备与其降低抑郁症状和提高 QOL 的可能性相关，对照顾者有益。对终末期癌症患者照顾者的支持性计划应不仅注重增强护理技能，还要培养对亲人死亡的情绪准备，以促进他们的心理健康和 QOL。
