Oregon Health & Science University, School of Nursing, USA.
University of Utah, Department of Sociology, USA.
Soc Sci Med. 2020 Dec;266:113455. doi: 10.1016/j.socscimed.2020.113455. Epub 2020 Oct 17.
DESIGN & METHODS: This study was a secondary analysis of spouses/partners (n = 198) who participated in the Cancer Caregiver Study. Latent profile mixture modeling was used to characterize caregiver health profiles from data collected prior to their spouse's death. Regression analyses were used to determine the impact of caregiver health profiles on the risk of developing prolonged grief symptoms (PG-13 scale).
Two health profiles were identified, one of which was comprised of a minority of caregivers (n = 49; 25%) who exhibited higher anxiety and depressive symptoms, greater health impact from caregiving, more self-reported health problems, and greater difficulty meeting physical demands of daily activities. Caregivers who were observed in this poorer health profile had significantly lower levels of active coping (p < 0.001) in adjusted models. Additionally, according to subsequent bereavement data, caregivers' preloss health profile was a significant predictor of developing prolonged grief symptoms (p = 0.018), controlling for caregivers' age (p = 0.040) and amount of active coping (p = 0.049), and there was a mediating effect of caregiver health on the relationship between active coping and prolonged grief symptoms.
Caregiving and bereavement should not be considered separately; caregivers adapt to bereavement with the resources and coping attained throughout the life course, culminating in the experience of providing end-of-life care. Interventions aimed at supporting caregivers and bereaved persons should focus on maintaining physical and mental health during stressful life transitions, and especially during the period in which they are providing care to a spouse at end-of-life.
1）描述癌症临终关怀照顾者在临终关怀期间身心健康的不同特征；2）确定与照顾者不同特征相关的背景和前期因素；3）确定照顾者特征与发生长期悲痛症状风险的相关性。
本研究是对参加癌症照顾者研究的配偶/伴侣（n=198）进行的二次分析。采用潜在剖面混合建模，根据配偶去世前收集的数据，描述照顾者健康特征。回归分析用于确定照顾者健康特征对发生长期悲痛症状（PG-13 量表）风险的影响。
确定了两种健康特征，其中一种由少数照顾者（n=49；25%）组成，这些照顾者表现出更高的焦虑和抑郁症状、更大的照顾健康影响、更多的自我报告健康问题以及更大的满足日常活动身体需求的困难。在调整后的模型中，处于这种较差健康特征的照顾者主动应对的水平明显较低（p<0.001）。此外，根据随后的丧亲数据，照顾者的失前健康特征是发生长期悲痛症状的一个显著预测因素（p=0.018），控制了照顾者的年龄（p=0.040）和主动应对的数量（p=0.049），照顾者健康对主动应对和长期悲痛症状之间关系具有中介作用。
照顾和丧亲不应单独考虑；照顾者在整个生命周期中利用资源和应对方式适应丧亲，最终经历提供临终关怀。旨在支持照顾者和丧亲者的干预措施应侧重于在压力大的生活转变期间，特别是在他们为临终配偶提供护理期间，维持身心健康。
