Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
권호 표지
DOI QR코드

DOI QR Code

Factors Associated with Care Burden among Family Caregivers of Terminally Ill Cancer Patients

말기암환자 가족 간병인의 간병 부담과 관련된 요인

  • Lee, Jee Hye (Department of Family Medicine, Gachon University Gil Medical Center) ;
  • Park, Hyun Kyung (Department of Family Medicine, Gachon University Gil Medical Center) ;
  • Hwang, In Cheol (Department of Family Medicine, Gachon University Gil Medical Center) ;
  • Kim, Hyo Min (Department of Family Medicine, Kyungpook National University Medical Center) ;
  • Koh, Su-Jin (Division of Hematology and Oncology, Department of Internal Medicine, Ulsan University Hospital) ;
  • Kim, Young Sung (Department of Family Medicine, Ilsan Hospital) ;
  • Lee, Yong Joo (Department of Palliative Medicine, Seoul St. Mary's Hospital) ;
  • Choi, Youn Seon (Department of Family Medicine, Korea University Guro Hospital) ;
  • Hwang, Sun Wook (Department of Family Medicine, St. Paul's Hospital) ;
  • Ahn, Hong Yup (Department of Statistics, Dongguk University)
  • 이지혜 (가천대 길병원 가정의학과) ;
  • 박현경 (가천대 길병원 가정의학과) ;
  • 황인철 (가천대 길병원 가정의학과) ;
  • 김효민 (칠곡경북대학교병원 가정의학과) ;
  • 고수진 (울산대학교병원 혈액종양내과) ;
  • 김영성 (일산병원 가정의학과) ;
  • 이용주 (서울성모병원 완화의학과) ;
  • 최윤선 (고려대학교 구로병원 가정의학과) ;
  • 황선욱 (성바오로병원 가정의학과) ;
  • 안홍엽 (동국대학교 통계학과)
  • Received : 2015.11.12
  • Accepted : 2016.01.21
  • Published : 2016.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: It is important to alleviate care burden for terminal cancer patients and their families. This study investigated the factors associated with care burden among family caregivers (FCs) of terminally ill cancer patients. Methods: We analyzed data from 289 FCs of terminal cancer patients who were admitted to palliative care units of seven medical centers in Korea. Care burden was assessed using the Korean version of Caregiver Reaction Assessment (CRA) scale which comprises five domains. A multivariate logistic regression model with stepwise variable selection was used to identify factors associated with care burden. Results: Diverse associating factors were identified in each CRA domain. Emotional factors had broad influence on care burden. FCs with emotional distress were more likely to experience changes to their daily routine (adjusted odds ratio (aOR), 2.54; 95% confidence interval (CI), 1.29~5.02), lack of family support (aOR, 2.27; 95% CI, 1.04~4.97) and health issues (aOR, 5.44; 2.50~11.88). Family functionality clearly reflected a lack of support, and severe family dysfunction was linked to financial issues as well. FCs without religion or comorbid conditions felt more burdened. The caregiving duration and daily caregiving hours significantly predicted FCs' lifestyle changes and physical burden. FCs who were employed, had weak social support or could not visit frequently, had a low self-esteem. Conclusion: This study indicates that it is helpful to understand FCs' emotional status and family functions to assess their care burden. Thus, efforts are needed to lessen their financial burden through social support systems.

목적: 말기암환자 가족 간병인의 간병 부담을 줄이는 것은 가족뿐 아니라 환자를 위해서도 중요하다. 본 연구에서는 말기암환자 가족 간병인의 간병 부담과 관련된 요인에 대해 살펴보았다. 방법: 국내 7개 기관의 완화의료병동에서 입원치료를 받는 말기암환자의 가족 간병인 289명의 자료를 분석하였다. 간병인이 느끼는 주관적 간병 부담은 암환자 가족 돌봄 경험 평가도구를 사용하였고, 5가지 차원에서 단계적 변수 선정을 사용한 로지스틱 회귀 모형을 통해 유의한 인자를 확인하였다. 결과: 간병부담의 각 차원에서 다양한 인자들과의 관련성이 확인되었다. 감정적 요인은 가장 폭넓은 영향을 미쳤는데, 감정적 스트레스를 가진 군은 그렇지 않은 군에 비해, 생활패턴이 변할 가능성이 2.54배(95% confidence interval, 1.29~5.02), 가족의 협조가 부족할 가능성이 2.27배(1.04~4.97), 그리고 신체적 부담이 커질 가능성이 5.44배(2.50~11.88)였다. 가족기능은 가족의 협조부족을 매우 잘 반영하였으며, 심한 가족기능 장애를 보일 경우 경제적 부담과도 관련이 있었다. 종교를 가진 군과 동반질환이 없는 군에서 오히려 간병 부담이 더 높은 것으로 나타났으며, 간병기간과 하루 중 간병시간은 생활패턴의 변화와 신체적 부담을 유의하게 예측하였다. 직업을 가지고 있거나, 사회적 지지가 부족하거나, 자주 방문하지 못하는 가족 간병인은 낮은 자아 존중감을 보였다. 결론: 본 연구 결과에 의하면, 가족 간병인의 간병 부담을 파악하기 위해서는 그들의 정서상태와 가족기능을 파악하는 것이 도움이 되며, 사회적 지지체계를 포함하여 경제적 부담을 완화시키는 노력이 필요하겠다.

Keywords

References

  1. Nijboer C, Tempelaar R, Sanderman R, Triemstra M, Spruijt RJ, van den Bos GA. Cancer and caregiving: the impact on the caregiver's health. Psychooncology 1998;7:3-13. https://doi.org/10.1002/(SICI)1099-1611(199801/02)7:1<3::AID-PON320>3.0.CO;2-5
  2. Goldstein NE, Concato J, Fried TR, Kasl SV, Johnson-Hurzeler R, Bradley EH. Factors associated with caregiver burden among caregivers of terminally ill patients with cancer. J Palliat Care 2004;20:38-43.
  3. Oliviere D, Monroe B, Payne S. Death, dying, and social differences. 2nd ed. Oxford:Oxford University Press;2011.
  4. Kim Y, Schulz R. Family caregivers' strains: comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving. J Aging Health 2008;20:483-503. https://doi.org/10.1177/0898264308317533
  5. Given BA, Given CW, Kozachik S. Family support in advanced cancer. CA Cancer J Clin 2001;51:213-31. https://doi.org/10.3322/canjclin.51.4.213
  6. Jung JG, Kim JS, Kim SS, Kang DS, Kim SM, Lee DH, et al. Quality of life among family caregivers of terminal cancer patient. Korean J Hosp Palliat Care 2006;9:1-10.
  7. Emanuel EJ, Fairclough DL, Slutsman J, Emanuel LL. Understanding economic and other burdens of terminal illness: the experience of patients and their caregivers. Ann Intern Med 2000;132:451-9.
  8. Shapiro J, Perez M, Warden MJ. The importance of family functioning to caregiver adaptation in mothers of child cancer patients: testing a social ecological model. J Pediatr Oncol Nurs 1998;15:47-54.
  9. Given B, Wyatt G, Given C, Sherwood P, Gift A, DeVoss D, et al. Burden and depression among caregivers of patients with cancer at the end of life. Oncol Nurs Forum 2004;31:1105-17. https://doi.org/10.1188/04.ONF.1105-1117
  10. Ham DO. A study family functions and nursing needs in cancer patient families [master's thesis]. Seoul: Chung-Ang Univ.; 2004. Korean.
  11. Park YH, Hyun HJ. Caregiver burden and family functioning of cancer patient. J Korean Acad Adult Nurs 2000;12:384-95.
  12. Kong EH. The influence of culture on the experiences of Korean, Korean American, and Caucasian-American family caregivers of frail older adults: a literature review. Taehan Kanho Hakhoe Chi 2007;37:213-20.
  13. Leow MQ, Chan MF, Chan SW. Predictors of change in quality of life of family caregivers of patients near the end of life with advanced cancer. Cancer Nurs 2014;37:391-400.
  14. Kang KA, Kim SJ. Content analysis of difficulties in families with terminal cancer patients. J Korean Acad Community Health Nurs 2005;16:270-81.
  15. Rhee YS, Shin DO, Lee KM, Yu HJ, Kim JW, Kim SO, et al. Korean version of the caregiver quality of life index-cancer (CQOLC-K). Qual Life Res 2005;14:899-904. https://doi.org/10.1007/s11136-004-1264-2
  16. Given CW, Given B, Stommel M, Collins C, King S, Franklin S. The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairments. Res Nurs Health 1992;15:271-83. https://doi.org/10.1002/nur.4770150406
  17. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5:649-55. https://doi.org/10.1097/00000421-198212000-00014
  18. Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 2002;20:494-502. https://doi.org/10.1200/JCO.2002.20.2.494
  19. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
  20. Oh SM, Min KJ, Park DB. A study on the standardization of the Hospital Anxiety and Depression Scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc 1999;38:289-96.
  21. Singer S, Kuhnt S, Gotze H, Hauss J, Hinz A, Liebmann A, et al. Hospital anxiety and depression scale cutoff scores for cancer patients in acute care. Br J Cancer 2009;100:908-12. https://doi.org/10.1038/sj.bjc.6604952
  22. Lim MK, Kim MH, Shin YJ, Yoo WS, Yang BM. Social support and self-rated health status in a low income neighborhood of Seoul, Korea. Korean J Prev Med 2003;36:54-62.
  23. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991;32:705-14. https://doi.org/10.1016/0277-9536(91)90150-B
  24. Yun BB, Kwak KW. The study of family APGAR socre as the evaluation method of the family function. Korean J Fam Med 1985;6:13-7.
  25. Smilkstein G. The family APGAR: a proposal for a family function test and its use by physicians. J Fam Pract 1978;6:1231-9.
  26. Smilkstein G, Ashworth C, Montano D. Validity and reliability of the family APGAR as a test of family function. J Fam Pract 1982;15:303-11.
  27. Yoon SJ, Kim JS, Jung JG, Kim SS, Kim S. Modifiable factors associated with caregiver burden among family caregivers of terminally ill Korean cancer patients. Support Care Cancer 2014; 22:1243-50. https://doi.org/10.1007/s00520-013-2077-z
  28. Northouse L, Williams AL, Given B, McCorkle R. Psychosocial care for family caregivers of patients with cancer. J Clin Oncol 2012;30:1227-34. https://doi.org/10.1200/JCO.2011.39.5798
  29. Mehrotra S, Sukumar P. Sources of strength perceived by females caring for relatives diagnosed with cancer: an exploratory study from India. Support Care Cancer 2007;15:1357-66. https://doi.org/10.1007/s00520-007-0256-5
  30. Thombre A, Sherman AC, Simonton S. Religious coping and posttraumatic growth among family caregivers of cancer patients in India. J Psychosoc Oncol 2010;28:173-88. https://doi.org/10.1080/07347330903570537
  31. Jang SN, Rhee SJ. A study on burden of family for caring of terminal cancer patients. J Korean Public Health Assoc 2000; 26:29-37.
  32. Yang EY, Kim YA. Burden and quality of life in terminal cancer patient's family caregivers in the area of Jeollanam-do. J Korea Acad Industr Coop Soc 2015;16:3954-62. https://doi.org/10.5762/KAIS.2015.16.6.3954
  33. van Ryn M, Sanders S, Kahn K, van Houtven C, Griffin JM, Martin M, et al. Objective burden, resources, and other stressors among informal cancer caregivers: a hidden quality issue? Psychooncology 2011;20:44-52. https://doi.org/10.1002/pon.1703
  34. Kim HS, Yu SJ. Factors influencing family functioning in family caregivers of patients with cancer. J Korean Acad Fundam Nurs 2008;15:301-11.
  35. Olson DH. Circumplex Model VII: validation studies and FACES III. Fam Process 1986;25:337-51. https://doi.org/10.1111/j.1545-5300.1986.00337.x
  36. Rodriguez-Sanchez E, Perez-Penaranda A, Losada-Baltar A, Perez-Arechaederra D, Gomez-Marcos MA, Patino-Alonso MC, et al. Relationships between quality of life and family function in caregiver. BMC Fam Pract 2011;12:19. https://doi.org/10.1186/1471-2296-12-19
  37. Kramer BJ, Boelk AZ, Auer C. Family conflict at the end of life: lessons learned in a model program for vulnerable older adults. J Palliat Med 2006;9:791-801. https://doi.org/10.1089/jpm.2006.9.791
  38. An YJ, Lee YS. Burnout and burden of family care-givers for caring of terminal patients with cancer. J Korean Oncol Nurs 2005;5:40-51.

Cited by

  1. The Effects of Stress and Stress Coping on Life Quality in Cancer Patients and Caregivers: A Dyadic Analysis Using an Actor-Partner Interdependence Model vol.18, pp.3, 2018, https://doi.org/10.5388/aon.2018.18.3.135
  2. Factors Influencing Burnout in Primary Family Caregivers of Hospital-based Home Care Patients vol.29, pp.1, 2018, https://doi.org/10.12799/jkachn.2018.29.1.54
  3. Relationship of ICU Nurses' Difficulties in End-of-Life Care to Moral Distress, Burnout and Job Satisfaction vol.25, pp.1, 2019, https://doi.org/10.11111/jkana.2019.25.1.42
  4. Bereaved Families’ Experiences of End-of-Life Care at Home for Older Adults with Non-Cancer in South Korea vol.36, pp.1, 2019, https://doi.org/10.1080/07370016.2018.1554768
  5. 호스피스 병동 말기 암 환자 가족의 돌봄 경험에 관한 현상학적 연구 vol.17, pp.10, 2016, https://doi.org/10.5392/jkca.2017.17.10.667
  6. The Experiences of Multiple Sclerosis Patients’ Family Caregivers at the First Hospitalization of Their Patients: A Qualitative Study vol.14, pp.None, 2016, https://doi.org/10.2147/ppa.s257746
  7. Caregiver burden: A concept analysis vol.7, pp.4, 2016, https://doi.org/10.1016/j.ijnss.2020.07.012
  8. The Mediating Effect of Depression on the Relationship between Social Support, Spirituality and Burnout in Family Members of Patients with Cancer vol.18, pp.4, 2016, https://doi.org/10.3390/ijerph18041727
  9. Caregivers' psychological suffering and posttraumatic growth after patient death vol.57, pp.3, 2016, https://doi.org/10.1111/ppc.12693