结构方程模型在癌症患者家属生活质量评价中的应用

目的:评价癌症患者家属的护理负担和生活质量,并对其影响因素进行研究.方法:采用中文版Zarit护理负担量表、癌症患者家属生活质量调查表和患者日常生活能力量表进行问卷调查.结果:结构方程模型拟合参数GFI=0.936,AGFI=0.860,CFI=0.959,模型拟合较好.护理负担显著影响护理者生活质量(P＜0.01),患者日常生活能力和护理者特征可通过影响护理负担,对护理者生活质量产生间接影响.结论:未来的干预措施应围绕改善患者日常生活能力和加强协助照顾来帮助护理者减轻负担,最终达到提高护理者生活质量的目的.     

肺癌患者照料者护理负担的影响因素研究

目的：通过测量肺癌患者照料者的护理负担,了解照料者的照顾负担及心理健康状况及其影响因素。方法：以Zarit护理者负担量表（Zarit caregiver burden interview,ZBI）量表为测量工具,采用横断面抽样方法,面对面结构化访谈收集调查问卷,对肺癌患者主要照料者的护理负担进行测量。结果：肺癌患者照料者护理负担得分为29．8±16．8,74．29％照料者的护理负担在中等以下。交通帮助和健康帮助对护理负担有显著影响,而睡眠时间和心理一致感是护理负担的保护性因素。结论：改善措施应围绕保证照料者睡眠时间来减轻护理工作量或建立轮流护理的补偿机制以及增强照料者心理一致感等心理应对能力来应对护理负担。     

家属联动干预模式对颅内肿瘤偏瘫患者肢体功能恢复及生活质量的影响

目的探讨家属联动干预模式对颅内肿瘤偏瘫患者肢体功能恢复及生活质量的影响。方法选取2017年3月至2019年3月间西安市第三医院收治的90例颅内肿瘤偏瘫患者,采用随机数字表法分为观察组和对照组,每组45例。对照组患者采用常规康复护理,观察组患者在对照组基础上联合家属联动干预康复护理模式,比较两组患者生活质量、肢体运动能力、日常生活能力、心理波动及症状评分等。结果护理后1个月,观察组患者生活质量各项评分均高于对照组,肢体运动能力和日常生活能力评分均高于对照组,焦虑自评量表和抑郁自评量表评分均低于对照组,症状评分均低于对照组,两组比较,差异均有统计学意义(均P <0. 05)。结论家属联动干预模式能提高颅内肿瘤偏瘫患者的生活质量、肢体运动能力和日常生活能力,改善心理波动,缓解偏瘫症状,值得推广应用。     

心理干预在恶性肿瘤患者围手术期的应用体会

目的：分析癌症患者对待手术的心理特征,探讨在临床护理过程中实施有效的心理干预对患者生存质量的影响。方法对60例因恶性肿瘤而接受手术治疗的患者进行不同的心理干预。对照组（30例）进行传统心理护理,干预组（30例）则从患者入院后以及手术前后均开展针对性心理护理干预,通过对比两组治疗前后焦虑自评量表（SAS）和抑郁自评量表（SDS）的评分结果评价护理结果。结果焦虑自评量表和抑郁自评量表的评分结果显示,干预组患者心理干预后评分显著降低（P ＜0．05）,而对照组患者心理护理前后评分没有发生有意义的变化（P＞0．05）,两组比较差异具有统计学意义（P＜0．05）。结论对癌症患者围手术期实施强化心理行为干预,可以减轻患者对手术的恐惧焦虑情绪,增强战胜癌魔的信心与勇气,提高患者及家属对护理工作的满意度。     

影响癌症患者情绪及生活质量的因素研究

[目的]研究影响癌症患者情绪及生活质量的主要因素。[方法]采用的“癌症患者生活质量FACT-G量表”，对住院肿瘤病人110例进行调查．采用方差分析和多元逻辑回归分析方法处理数据。[结果]影响癌症患者情绪的因素主要有：性别、知情状况、体能评分、疼痛程度，多元逻辑回归显示这些因素与患者情绪有显著性相关性（P=0．022，0．006，0．012，0．004）。本组患者对病情完全知情的比例为34．5％，其余为部分知情（28．1％）和完全不知情（37.4％）。知情状况对患者的情绪和功能状况有显著性影响，尤其是对情绪的影响最强。[结论]与癌症患者情绪密切相关的主要因素分别是性别、知情状况、体能评分和疼痛程度。知情对患者的生活质量中的情绪和功能状况可能产生影响。     

乳腺癌患者生存质量影响因素分析

目的对乳腺癌患者生存质量进行测量和综合评价,筛选出影响乳腺癌患者生存质量的因素,为提高患者生存质量提供建议。方法利用癌症治疗方法评估表-乳腺癌分量表（FACT—B）、症状自评量表SCL-90和社会支持量表,采用调查病例、面访与问卷相结合的方法对260例乳腺癌住院患者的生存质量进行测量和评价。采用SPSS13．0软件对数据进行统计学分析,筛选出影响乳腺癌患者生存质量的主要因素。结果影响生存质量总分因素为经济状况（偏回归系数β=2．024,P=0．003）、情绪调节能力（β=4．993,P=0．000）以及婚姻质量自我评价（β=-3．954,P=0．001）;影响生理领域得分的因素为情绪调节能力（β=0．987,P：0．008）以及应激事件次数（β=-0．866,P=0．011）;影响社会家庭领域得分的因素为经济状况（β=1．016,P=0．000）、婚姻状况（β=-1．018,P=0．041）、情绪调节能力（β=0．971,P=0．008）以及婚姻质量自我评价（β=-1．382,P=0．001）;影响情感领域得分的因素为情绪调节能力（β=1．094,P=0．000）和婚姻质量自我评价（β=-0．892,P=0．006）;影响功能领域得分的影响因素为地区因素（β=1．653,P=0．008）、情绪调控能力（β=0．962,P=0．01）以及生活质量自我评价（β=-1．705,P=0．000）。结论指导患者正确认识乳腺癌,坚定生活信心,加强康复锻炼,并使患者拥有良好的家庭环境和必要的社会福利保证等可促进其功能恢复,进而提高生存质量。     

心理干预对癌症患者及主要照顾者依从性和生活质量的影响

 目的　探讨心理干预对癌症患者及主要照顾者的依从性和生活质量的影响,以及患者心理问题和主要照顾者心理问题之间的相关性。方法　将入组患者随机分成干预组和对照组,干预组给予规范抗肿瘤治疗的同时对患者及主要照顾者进行每周一次的心理干预治疗。对照组仅给予规范的抗肿瘤治疗。使用TDL生活质量测定表、焦虑自评量表（SAS）、抑郁自评量表（SDS）等,在心理干预前、干预8周后对两组患者及主要照顾者分别进行2次问卷调查;并记录两组患者对计划治疗的完成情况。应用SPSS 12.0软件完成数据统计。结果　干预组患者能完成预计治疗的人数比为51例,对照组为38例,两者比较差异具有统计学意义（P＜0.05）;干预组患者及其家属的TDL生活质量测定评分明显高于对照组（P＜0.05）;干预组患者及其家属的焦虑自评量表（SAS）、抑郁自评量表（SDS）评分明显低于对照组（P＜0.05）。结论　在癌症患者的治疗过程中对患者及主要照顾者加入有效的心理干预治疗,能提高癌症患者的依从性,能提高癌症患者及主要照顾者的生活质量,且患者心理问题和主要照顾者心理问题之间存在正相关性。     

肿瘤患者化疗期间的生活质量调查与分析

目的：探讨肺癌、乳腺癌及消化道恶性肿瘤患者化疗期间的生活质量状况及其影响因素。方法：选用生活质量问卷（QLQ—c30，QLQ—LC13，QLQ—BR21）对267名化疗患者进行调查，统计学方法采用t检验及多因素相关分析。结果：肺癌和消化道肿瘤患者生活质量在化疗前、化疗早期及后期组间未见统计学差异；乳腺癌患者化疗后较化疗前在疲乏（P=0．010）、失眠（P=0．007）、恶心呕吐（P=0．0001）及厌食（P=0．016）方面呈加重趋势，认知功能也在一定程度上受到损害（P=0．020）。生活质量影响因素之间的交互作用明显，经济因素明显影响肿瘤患者的生活质量。结论：乳腺癌患者化疗期间疲乏、失眠及消化道症状呈加重趋势，经济因素对癌症患者生活质量的影响不容忽视。     

全程护理干预对肺癌化疗患者生活质量的影响

目的：探讨全程护理干预对肺癌化疗患者生活质量的影响。方法：将76例接受含铂双药联合化疗方案的肺癌患者随机分为对照组（n=38）和观察组（n=38）。对照组采用化疗常规护理,观察组采用常规护理及全程护理干预。两组患者在治疗前和治疗后采用欧洲癌症化疗患者生活质量量表进行问卷调查。评估全程护理干预对肺癌化疗患者生活质量的影响。结果：两组患者化疗后功能子量表和总体生活质量评分较化疗前均降低。但观察组较对照组降幅小,两组评分变化比较具有统计学意义（P〈0.05）。两组患者化疗后症状子量表及反映症状和经济状况的特异性项目评分较化疗前均有升高,除呼吸困难、便秘症状和经济状况外,其他项目评分观察组升高值小于对照组,两组评分变化比较差异有统计学意义（P〈0.05）。结论：对肺癌化疗患者实施全程护理干预,能有效改善化疗后生活质量,减轻化疗相关症状,值得临床推广。     

老年综合评估在老年胃肠道肿瘤手术患者中的应用效果

目的 探讨老年综合评估(comprehensive geriatric assessment,CGA)对老年胃肠道肿瘤手术患者日常生活能力?生活质量及护理不良事件的影响。方法 选取2015年4月至2016年4月我院收治的260例老年胃肠道肿瘤手术患者,随机分为观察组(n=130)和对照组(n=130)。对照组采用常规护理模式,观察组在常规护理的基础上实施CGA,分别于干预前和干预后1个月,采用日常生活能力量表(activity of daily living scale,ADL)和欧洲癌症研究与治疗组织生存质量问卷第3版评估两组患者的日常生活能力、生活质量,并观察护理不良事件的发生情况。结果 观察组干预前后的ADL评分差值高于对照组[(30.74±0.68) 分 vs (11.63±0.73) 分, t=218.40, P<0.001],总健康状况及功能领域评分差值均高于对照组(P<0.05),两组主要症状领域和单项测量项目(除经济困难外)干预后的评分均低于干预前(P<0.05)。观察组患者护理不良事件的总发生率低于对照组(6.15% vs 16.15%,χ²=6.559, P=0.010)。结论 对老年胃肠道肿瘤手术患者采取CGA可改善其日常生活能力及生活质量,并减少护理不良事件的发生。     

Living longer with adult high-grade glioma:setting a research agenda for patients and their caregivers

The long-term survival of patients with adult high-grade glioma (HGG) remains poor, but for those who do live longer functional status and neurocognitive ability may be influenced by residual or recurrent tumour, or treatment-related complications. The aim of this review was to examine the current literature regarding the quality of life and experience of patients living longer with adult HGG and their caregivers, with a view to understanding the burden of treatment on patient abilities and deficits over time. Medline, PsychINFO and CINAHL databases were searched for the core concept of HGG in combination with an aspect of quality of long-term survival. Key findings of the 12 included studies were identified and synthesised thematically. There is a paucity of dedicated studies which have investigated the experiences of this cohort. The strength of existing literature is limited by the systematic exclusion of the poorest functioning patients and the under-representation of caregiver perspectives. Discrepancies in how patients view their quality of life were highlighted, despite consistent findings of significant physical and functional impairment. This review confirmed the presence of important differences between patient and caregiver views regarding patient abilities following treatment. Caregiver burden was found to be high, due to multiple dynamic and relentless stressors. The true experience of patients living longer with adult HGG and their caregivers remains unclear, particularly for patients with poorer neurocognitive and functional outcomes. Further research is required to clarify and replicate findings, explore discrepancies between patient and caregiver views, and to specifically investigate how caregiver needs and experiences may evolve over time.     

The Burden of Care and Quality of Life of Caregivers of Leukemia and Lymphoma Patients Following Peripheric Stem Cell Transplantation

This study was conducted to identify the burden of care and quality of life of caregivers of leukemia and lymphoma patients who had undergone peripheric stem cell transplantation. The sample consisted of 123 patient caregivers, all of whom were relatives. Data were collected using a survey, the Burden Interview, and the Caregiver Quality of Life Index Cancer Scale. Data evaluation was done using correlation analysis, Kruskall Wallis, and Mann-Whitney U tests. Factors that were significantly associated with quality of life and care burden perception included caring for an older patient, patient dependence for daily activities, and having low economic status.     

Burden,emotional distress and quality of life among informal caregivers of lung cancer patients: An exploratory study

This study was conducted to explore the interrelationships among caregiver burden, emotional status and quality of life (QoL) in caregivers of lung cancer patients, and to identify whether caregiver burden and health status are associated with patient emotional status and QoL. Forty‐three dyads of lung cancer patients and their caregivers were included for analysis. Caregiver‐reported outcomes were measured by Caregiver Burden Scale (CBS), Caregivers Quality of Life Index‐Cancer (CQOLC) and Hospital Anxiety and Depression Scale (HADS), while patient‐reported outcomes were collected by HADS and Lung Cancer Symptom Scale (LCSS). The majority of the CBS and CQOLC scores were significantly higher in anxious and depressed caregivers than non‐anxious and non‐depressed caregivers (p < .01 or .05). Caregivers of depressed patients experienced significantly greater emotional distress than those of non‐depressed patients (p < .01). Significantly positive associations were identified among most of the CBS, CQOLC and caregiver HADS scores. Patient LCSS scores were positively correlated with the CBS and caregiver HADS scores, and patient HADS scores were also positively related to caregiver HADS scores. The close interrelationships between caregiver and patient health outcomes provide evidence that lung cancer patients and their caregivers should be viewed as a unit in future supportive service models.     

A Prospective Pilot Study of Psychosocial Functioning in Head and Neck Cancer Patient–Caregiver Dyads

This study explored the psychosocial functioning of 10 head and neck cancer patient–caregiver dyads over the radiation/chemoradiation (radiation or combined chemoradiation) treatment period, including the interdependence in patient–caregiver quality of life (QOL). Dyads were recruited prior to or at the initiation of radiation/chemoradiation treatment. Patient QOL decreased across the treatment trajectory, and many caregiver QOL subscales decreased during the middle of treatment. Caregiver burden increased over the treatment trajectory with levels remaining relatively low. Patients and caregivers demonstrated interdependence in QOL toward the middle and conclusion of treatment. Patients demonstrated more depression than caregivers at all time points. Results suggest that both members of the dyad should be targeted for psychosocial interventions during radiation/chemoradiation treatment period.     

Understanding burden in caregivers of colorectal cancer survivors: what role do patient and caregiver factors play?

This study investigated how both caregiver and patient factors predict different aspects of burden in colorectal cancer caregivers. One hundred and fifty‐three caregiver–survivor dyads separately provided information on patient disease and treatment‐related factors, and perceived global health status (EORTC QLQ30), along with caregiver socio‐demographic factors, health and care‐related activities. Four multiple regression analyses were conducted to assess the influence of caregiver characteristics, patient characteristics and care‐related activities on four dimensions of burden from the Caregiver Reaction Assessment scale. Caregiver characteristics significantly predicted health and financial burden (11%–13% of explained variance) with comorbidity and younger age increasing this risk. Patient health, in particular global health status and the presence of a stoma, predicted all burden scores, explaining 14%–22% of variance. Care‐related activities was also a significant predictor of all burden scores, explaining an additional 5%–11% of variance, with time involved in caring the most consistent predictor. Results highlight that a combination of factors influence caregiver burden. These results may be used to identify those most at risk, allowing practitioners to deliver tailored effective support. In particular, efforts to alleviate the burden of caring on caregiver schedule may be merited, given that this was the domain in which the burden was greatest.     

Underestimated caregiver burden by cancer patients and its association with quality of life,depression and anxiety among caregivers

This study examined how patients with cancer estimate caregiver burden (CB) and the association between their underestimation of CB and their caregivers' self‐ratings of their quality of life (CQOLC‐K; Korean version of the Caregiver Quality of Life Index‐Cancer), depression and anxiety (Korean version of the Hospital Anxiety and Depression Scale). Participants consisted of 990 patient‐caregiver dyads recruited from a nationwide cross‐sectional survey conducted in South Korea. Medical baseline data were retrieved from the hospital information systems of the participating centres. The patients with cancer who underestimated CB ranged from 18.62% (for physical CB) to 23.33% (for social CB). They had less advanced cancer, a lower income, were the caregiver's spouse, reported higher levels of family avoidance of communication about cancer, and had female caregivers. The patients' underestimation of CB was significantly related to lower CQoL and higher levels of caregiver depression and anxiety. The current study provides empirical evidence for the link between the underestimation of CB by patients with cancer and compromised caregiving experiences of cancer caregivers. Open family communication about cancer was discussed as one of several practical strategies for decreasing patients' underestimation of CB.     

Quality of Life of Male Spouse Caregivers for Breast Cancer Patients in China

Background: The aim of this study was to describe the characteristics of male spouse caregivers of breastcancer patients in China, assess their quality of life (QOL), and investigate the influencing factors. Materialsand Methods: A total of 243 breast cancer patient-spouse caregiver dyads were recruited from four hospitalsin Shanxi and Anhui province of China. A cross-sectional design was applied to collect data and the Chineseversion of the Medical Outcomes Study 36-item Short Form (SF-36) was used to measure caregivers’ QOL, andthe Chinese version of M.D. Anderson Symptom Inventory (MDASI-C) was applied to measure patient symptomseverity and interference. Pearson’s correlation was used to examine the correlations between caregiver burdenand QOL. The multiple regression analysis was used to determine the most predictive factors influencing QOL.Results: The scores of all SF-36 scales were above 50.0, which were much lower than that of general mainlandChinese males. Mental QOL was significantly worse than physical QOL. Spouses demographic characteristics,caregiving-related variables and patient symptoms were related to spouse QOL. Caregiver burden has a negativerelationship with QOL. Conclusions: A decrease in life events and patient symptoms, as well as increase in spousesleeping time and family income, ought to improve QOL.     

Poor patient health is associated with higher caregiver burden for older adults with advanced cancer

ObjectivesFamily caregiver burden among older adults with advanced cancer remains poorly understood. We sought to (1) identify patient factors associated with caregiver burden and (2) examine how amount of time caregiving modifies these relationships.MethodsCross-sectional analysis of baseline data from a cluster-randomized palliative care intervention trial including patients with advanced cancer and their family caregivers, recruited from 17 oncology practices in Pennsylvania. Caregiver burden was measured using Zarit Burden Interview (ZBI-12; range 0–48). Patient factors included functional status (Eastern Cooperative Oncology Group), symptom burden (Edmonton Symptom Assessment Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and quality of life (Functional Assessment of Chronic Illness Therapy – Palliative Care). Using adjusted multivariable regression, we analyzed (1) independent associations between patient factors and caregiver burden and (2) how weekly caregiving hours modified these relationships.ResultsAmong 441 patient-caregiver dyads, mean patient age was 70 ± 10 and caregiver age was 62 ± 13 years. Most caregivers (59%) were patients' partners. Caregivers reported 44.5 ± 53.5 average hours spent caregiving weekly; mean ZBI-12 scores were 10.3 ± 7.3. Worse patient functional status (β = 4.20, p < 0.01), poorer quality of life (β = ?0.07, p < 0.01), more anxiety (β = 0.33, p < 0.01) and depression (β = 0.33, p < 0.01) were associated with higher caregiver burden; caregiving hours did not affect these relationships.ConclusionsIn advanced cancer, poor patient physical and mental health is associated with higher caregiver burden regardless of hours caregiving; future studies should examine interventions tailored to alleviate caregiver burden for this group.