A Longitudinal Study On The Care Burden Of Family Caregivers Of Patients With Colorectal Cancer And Its Influencing Factors

Objective:Through longitudinal study,to understand the level of care burden of family caregivers of colorectal cancer patients in postoperative,mid-term chemotherapy,three months and six months after operation;to analyze the track of care burden of family caregivers of colorectal cancer patients from postoperative to six months after operation;and to analyze the influencing factors of care burden of family caregivers of colorectal cancer patients at different time points.Methods:This Under the guidance of caregiver adaptation model and cancer family care model,the study adopted convenient sampling method.From December 2018 to December 2019,170 pairs of colorectal cancer patients met the exclusion criteria in the Cancer Hospital of Chinese Academy of Sciences,Beijing Shijitan Hospital,The First Affiliated Hospital of Inner Mongolia University,Erdos Central Hospital,Hebei cancer hospital and other hospitals Patients and their family caregivers carried out questionnaire survey after operation,chemotherapy,3 months after operation and 6 months after operation.The survey tools included patients’general information questionnaire,disease-related information questionnaire,eortc-qol-c30,caregiver general information questionna:ire,general self-efficacy scale(GSEs)Social support rating scale,caregiver care ability scale(FCTI),simple coping scale,and caregiver response assessment scale(CRA).Spss22.0,Mplus and SAS statistical analysis software were used to input and analyze the data,including descriptive analysis,correlation analysis,single factor and multiple stepwise regression analysis,latent variable classification growth model,etcResults:(1)The quality of life of patients with colorectal cancer changes over time,and its five functional areas and total health show a trend of first decline and then increase,and the five functional areas and total health scores are the lowest in the middle stage of chemotherapy;their symptoms of fatigue,nausea,vomiting,and pain It showed a trend of rising first and then falling,which was the most severe in the middle stage of chemotherapy.The patient’s insomnia symptoms continued to decline,which was more serious after surgery.At the end of chemotherapy,the patient’s financial difficulties scored the highest.(2)The family caregivers of patients with colorectal cancer generally have a burden of care.The ones that have a greater impact on the caregivers are "time is disturbed" and "economic two dimensions";the burden of care first increases and then decreases during the follow-up period,which is more serious in the middle of chemotherapy..Caregivers’ self-efficacy,sociall support,and positive response showed a trend of decreasing first and then rising,with the lowest scores in the middle stage of chemotherapy;while caregiving capacity and negative coping trends increased first and then decreased,and scored higher in the middle stage of chemotherapy.(3)There are different factors influencing the burden of care of family caregivers of colorectal cancer patients in different periods.Clinical staff should make targeted interventions according to different factors..After surgery,the factors that affect the burden of care include:rectal cancer patients,patients with higher income,poor cognitive function,and caregiver factors include:caregivers need to care for others,lack of care ability and take negative response,which will increase the burden of care.In the middle stage of chemotherapy,the effect of nursing burden is from nausea and vomiting,gender,emotional function,negative response of caregiver and caregiver nationality.Among them,the patients were male,with poor emotional function,and the severe nausea and vomiting symptoms would increase the burden of care;the caregivers were ethnic minorities and the negative coping measures would increase the burden.After chemotherapy,patients with severe symptoms such as open surgery,nausea and vomiting,and shortness of breath have heavy burden on caregivers;caregivers with high level of social support and less negative response will reduce the burden of care.In the last follow-up,the main factors to increase the burden of care are low income,poor physical function,constipation and low level of social support.(4)The growth burden model was used to divide the care burden into three latent categories:the low-burden rise-up and then-decrease group(12.97%),the medium-burden rise and fall-down group(55.14%),and the high-burden rise and fall-down group(31.89)%).Different groups have different influencing factors for the burden of care.The influencing factors of the low-burden group are the patient’s age(β=-1.501,P=0.002),the patient’s gender(β=5.714,P=0.020),and the degree of self-care(β=5.464).,P=0.003),fatigue(β=0.079,P=0.011),loss of appetite(β=3.101,P=0.009),caregiver age(β=3.364,P=0.000),education level(β=-2.206,P=0.000),living with patients(β=4.881,P=0.000),length of care(β=3.932,P=0.000),general self-efficacy(β=-0.273,P=0.000),ability to care(β=1.710,P=0.000).Middle burden group and patients’ body function(β=-0.054,P=0.023),role function(β=-0.070,P=0.001),social function(β=-0.016,P=0.046),fatigue(β=0.085,P=0.000),nausea and vomiting(β=0.080,P=0.000),insomnia(β=0.029,P=0.005),economic difficulties(β=0.030,P=0.001),and the number of caregivers sharing care for patients(β=-1.133,P=0.002)Social support(β=-0.309,P=0.000),care ability(β=0.202,P=0.002),negative coping(β=0.348,P=0.001)were related.The influencing factors of high burden group were patients’ self-care level(β=1.348,P=0.047),general health status(β=-0.097,P=0.012),fatigue(β=1.072,P=0.013),nausea and vomiting(β=0.064,P=0.010),pain(β=0.084,P=0.016),caregiver’s age(β=-0.322,P=0.029),living in rural areas(β=-1.772,P=0.012),length of care(β=0.273,P=0.001),number of patients sharing care(β=-2.501,P=0.002),general self-efficacy(β=-0.207,P=0.045),social support(β=-0.312,P=0.025),care ability(β=0.354.P=0.000).(5)Through the analysis of the relationship between the caregiver’s care burden and the patient’s quality of life,we found that:the model fitting results were good,the quality of life of patients with colorectal cancer after operation was affected by the care burden of the caregiver after operation(β=-0.387,P=0.000);the quality of life of patients in the middle stage of chemotherapy was affected by the care burden of the caregiver after operation(β=-0.779,P=0.004)and the simultaneous stage(β=-10.808,P=0.000)the burden of care,the burden of care in the middle stage of chemotherapy(P=0.846)and the end of chemotherapy(P=0.992)could not effectively predict the quality of life of patients after chemotherapy;the quality of life of patients three months after chemotherapy was affected by the burden of care in the same period(β=-9.474,P=0.000)and the end of chemotherapy(β=-4.987,P=0.013).Conclusion:①The care burden of family caregivers of colorectal cancer patients changes with time,and the overall trend is to rise first and then decrease.The sub-burdens of all dimensions of the care burden also show a trend of rising first and then decreasing over time The care burden is heavier in the middle of chemotherapy.②The influencing factors of family caregiver’s care burden of colorectal cancer patients in different periods are different,which suggests that clinical staff should pay attention to the social support and coping style of caregivers,but also take different intervention measures in combination with different influencing factors of care burden in different periods.③In general,the quality of life of patients and the general self-efficacy,social support and care ability of caregivers have a greater impact on the care burden of each sub category group,but each sub category group has its own unique influencing factors,suggesting that medical staff identify the care burden degree according to the different characteristics of patients and caregivers,or according to different processes to take care of the burden of targeted intervention.④According to the Actor-Partner Interdependence Model,we can know that the quality of life of patients with colorectal cancer is affected by the caregiver’s burden of care.The heavier the burden of the caregiver,the lower the quality of life of the patient.And the caregiver’s burden of care is also affected by the quality of life of the patient,prompting medical staff to treat patients and their caregivers as a unit of care and serve them together in the patient’s disease trajectory.