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黑人和白人临终关怀家庭照顾者的焦虑、抑郁、生活质量、照顾者负担和以照顾者为中心的沟通感知。

Anxiety, Depression, Quality of Life, Caregiver Burden, and Perceptions of Caregiver-Centered Communication among Black and White Hospice Family Caregivers.

机构信息

Department of Biobehavioral and Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Department of Social Work, College of Humanities and Social Sciences, North Carolina State University, Raleigh, North Carolina, USA.

出版信息

J Palliat Med. 2022 Apr;25(4):596-605. doi: 10.1089/jpm.2021.0302. Epub 2021 Nov 18.

Abstract

Anxiety, depression, and reduced quality of life (QOL) are common problems for hospice family caregivers, but it is unknown if disparities in these experiences exist among Black and White caregivers. To compare anxiety, depression, QOL, caregiver burden, and perceptions of caregiver-centered hospice team communication between Black and White hospice family caregivers. Secondary analysis of baseline data from two randomized clinical trials. Seven hundred twenty-two Black and White hospice family caregivers ages 18+ from Midwestern and Northeastern United States. Measures included the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9), Caregiver Quality-of-Life Index-Revised (CQLI-R), Zarit Burden Interview (ZBI-7), and Caregiver-Centered Communication Questionnaire (CCCQ). Black and White caregivers differed across demographic and socioeconomic variables. Nearly one-third of hospice family caregivers reported moderate-to-severe anxiety (32.1%) and moderate-to-severe depressive symptoms (32.0%). White caregivers reported lower QOL than Black caregivers ( = 0.04), specifically in emotional ( = 0.02) and social ( = 0.0005) domains. In multiple regression analyses controlling for caregiver and patient factors, we found no racial differences in depression, anxiety, QOL, caregiver burden, or perceptions of caregiver-centered hospice communication. Despite demographic and socioeconomic differences, Black and White hospice family caregivers experience similarly high levels of anxiety, depression, burden, and perceptions of hospice communication. Interventions to support hospice family caregivers across racial groups and research that identifies factors that mediate social determinants of health in this population are needed. The development and validation of culture-concordant mental health screening tools in racially diverse populations is recommended. Trial registration: ClinicalTrials.gov NCT02929108 and ClinicalTrials.gov NCT01444027.

摘要

焦虑、抑郁和生活质量(QOL)下降是临终关怀家庭照顾者常见的问题,但尚不清楚这些经历在黑人和白人照顾者中是否存在差异。本研究旨在比较黑人和白人临终关怀家庭照顾者的焦虑、抑郁、QOL、照顾者负担以及对以照顾者为中心的临终关怀团队沟通的看法。这是两项随机临床试验的基线数据的二次分析。研究对象为来自美国中西部和东北部的 722 名年龄在 18 岁及以上的黑人和白人临终关怀家庭照顾者。测量工具包括广泛性焦虑障碍 7 项量表(GAD-7)、患者健康问卷(PHQ-9)、照顾者生活质量指数修订版(CQLI-R)、Zarit 负担量表(ZBI-7)和以照顾者为中心的沟通问卷(CCCQ)。黑人和白人照顾者在人口统计学和社会经济变量方面存在差异。近三分之一的临终关怀家庭照顾者报告有中度至重度焦虑(32.1%)和中度至重度抑郁症状(32.0%)。与黑人照顾者相比,白人照顾者的 QOL 较低( = 0.04),特别是在情感( = 0.02)和社会( = 0.0005)领域。在控制了照顾者和患者因素的多变量回归分析中,我们没有发现种族差异与抑郁、焦虑、QOL、照顾者负担或对以照顾者为中心的临终关怀沟通的看法有关。尽管存在人口统计学和社会经济差异,但黑人和白人临终关怀家庭照顾者经历着同样高水平的焦虑、抑郁、负担和对临终关怀沟通的看法。需要针对不同种族群体的临终关怀家庭照顾者开展干预,并研究确定影响该人群健康社会决定因素的因素。建议在种族多样化人群中开发和验证文化一致的心理健康筛查工具。试验注册:ClinicalTrials.gov NCT02929108 和 ClinicalTrials.gov NCT01444027。

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