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Choi, Bae, Kim, and Tae: Factors Influencing Burden among Family Caregivers of Elderly Cancer Patients
Original Article

Asian Oncology Nursing 2016; 16(1): 20-29.

Published online: 31 March 2016

DOI: https://doi.org/10.5388/aon.2016.16.1.20

Factors Influencing Burden among Family Caregivers of Elderly Cancer Patients

Yooun Sook Choi1, Joo Hee Bae2, Nam Hee Kim2, Young Sook Tae3

1Department of Nursing, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea.

2Kosin University, Research Institute of Holistic Nursing Science, Busan, Korea.

3College of Nursing, Kosin University, Busan, Korea.

Address reprint requests to: Tae, Young Sook. College of Nursing, Kosin University, 34 Amnam-dong, Seo-gu, Busan 49267, Korea. Tel: +82-51-990-6446 Fax: +82-51-990-3031, taehope@kosin.ac.kr

Received 2 December 2015       Revised 2 February 2016       Accepted 22 March 2016

© 2016 Korean Oncology Nursing Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was to identify factors influencing burden among family caregivers of elderly cancer patients.

Methods

The participants were 217 family caregivers who visited inpatient & outpatient clinics for elderly cancer patients at two general hospitals. Data were collected utilizing the Perceived Health Status Scale, Herth Hope Index Scale, Medical Outcome Study-Social Support Scale, and Caregiver Reaction Assessment Scale.

Results

The level of burden in the participants was moderate to high. There were significant correlations among perceived health status, hope, social support and burden. In multiple regression analyses, the most powerful predictor of burden in family caregivers was hope (36.0%). Overall, other caregivers, perceived economic status, caring time, gender, patients' confusion, tangible support, and perceived health status explained 61.0% of the variance of burden among the participants.

Conclusion

The study highlights the importance of hope on burden in family caregivers. Thereby, integrative interventions are needed to enhance hope and social support and to promote caregivers' health status for alleviating-burden among family caregivers.

Keywords: Aged, Neoplasms, Family Caregivers, Burden of Illness

Figures and Tables

Table 1

Burden of Family Caregivers by General Characteristics (N=217)

aon-16-20-i001
Characteristics Categories n (%) M ± SD t or F p Scheffé
Age (year) (M ± SD = 57.3 ± 13.2) < 40a 28 (12.9) 47.64 ± 8.71 10.35 < .001 d > a,b
40~49b 50 (23.0) 47.50 ± 9.08
50~59c 27 (12.5) 52.74 ± 9.86
60~69d 81 (37.3) 57.30 ± 9.73
≥ 70e 31 (14.3) 55.35 ± 11.86
Gender Female 165 (76.0) 54.64 ± 10.72 - 4.33 < .001
Male 52 (24.0) 47.60 ± 8.40
Relationship with patients Spousea 113 (52.1) 56.63 ± 10.06 11.42 < .001 a > b,c
Childrenb 76 (35.0) 49.13 ± 8.79
Son/daughter in lawc 20 (9.2) 44.55 ± 10.17
Othersd 8 (3.7) 57.60 ± 10.30
Live with patients Yes 146 (67.3) 55.45 ± 10.40 5.26 < .001
No 71 (32.7) 47.82 ± 9.21
Marital status Unmarried 30 (13.8) 49.17 ± 6.76 2.35 .098
Married 178 (82.0) 53.47 ± 10.86
Others 9 (4.2) 55.22 ± 14.45
Educational attainment < Middle schoola 81 (37.3) 59.23 ± 9.97 30.02 < .001 a > b,c
High schoolb 80 (36.9) 50.31 ± 9.30
> Universityc 56 (25.8) 47.63 ± 8.80
Occupation Yes 49 (22.6) 47.24 ± 8.93 - 4.45 < .001
No 168 (77.4) 54.61 ± 10.53
 Leave 27 (12.4) 53.63 ± 11.93
 Resignation 18 (8.3) 51.72 ± 7.92
 Retirement 14 (6.5) 50.64 ± 10.06
 Housewife 108 (49.7) 55.88 ± 10.52
 Student 1 (0.5) 52.00 ± 0.00
Religion Yes 164 (75.6) 53.10 ± 10.80 - 0.36 .719
No 53 (24.4) 52.49 ± 10.16
Perceived economic status Higha 16 (7.4) 47.19 ± 7.85 36.14 < .001 c > a,b
Middleb 140 (64.5) 49.93 ± 8.93
Lowc 61 (28.1) 61.39 ± 10.19
Chronic disease None 135 (62.2) 51.41 ± 10.52 4.15 .017
1 60 (27.6) 54.97 ± 10.43
≥ 2 22 (10.2) 56.91 ± 10.30
Duration of caregiving (month) (M±SD=14.60±18.91) ≤ 1 53 (24.4) 49.53 ± 1.57 3.50 .016
2~11 72 (33.2) 53.32 ± 1.15
12~23 40 (18.4) 56.53 ± 1.63
≥ 24 52 (24.0) 53.17 ± 1.45
Time for caregiving (hour) (M±SD=12.87±8.52) ≤ 5a 66 (30.4) 48.17 ± 9.00 9.96 < .001 a < d
6~11b 41 (18.9) 51.90 ± 9.97
12~17c 33 (15.2) 53.79 ± 8.79
≥ 18d 77 (35.5) 57.25 ± 11.28
Leisure activity Nonea 122 (56.2) 56.58 ± 10.57 19.23 < .001 a > b,c
Sometimesb 82 (37.8) 48.54 ± 8.39
Regularc 13 (6.0) 46.69 ± 10.63
Other caregivers No 90 (41.5) 59.49 ± 9.85 8.91 < .001
Yes 127 (58.5) 48.32 ± 8.54
 Family 112 (51.6) 47.79 ± 8.34
 Hired caregiver 12 (5.5) 53.50 ± 9.37
 Acquaintance 3 (1.4) 47.00 ± 8.19
Table 2

Burden of Family Caregivers by General Characteristics of Patients (N=217)

aon-16-20-i002
Characteristics Categories n (%) M ± SD t or F p Scheffé
Age (year) (M ± SD = 72.7 ± 5.7) 65~74 144 (66.4) 53.08 ± 10.88 0.07 .935
75~84 67 (30.8) 52.60 ± 10.18
≥ 85 6 (2.8) 53.83 ± 10.91
Gender Female 79 (36.4) 49.25 ± 9.49 4.01 < .001
Male 138 (63.6) 55.07 ± 10.69
ECOG PS ≤1a 48 (22.1) 49.25 ± 12.01 8.82 < .001 c > a,b
2b 115 (53.0) 52.32 ± 8.95
3c 54 (24.9) 57.57 ± 11.18
Insurance Yes 64 (29.5) 51.27 ± 10.24 - 1.51 .131
No 153 (70.5) 53.65 ± 10.74
Paying for medical expenses Patient 62 (28.6) 54.02 ± 11.20 0.31 .870
Spouse 35 (16.1) 52.20 ± 10.32
Children 90 (41.5) 52.78 ± 10.40
Health insurance 18 (8.3) 52.94 ± 11.67
Others 12 (5.5) 50.92 ± 9.65
Type of cancer Stomacha 37 (17.1) 53.14 ± 8.65 4.66 < .001 d < c,e,f
Colonb 30 (13.8) 53.73 ± 11.06
Lungc 56 (25.8) 55.11 ± 10.90
Female reproductived 41 (18.9) 46.24 ± 8.56
Hepatobiliarye 33 (15.2) 54.91 ± 9.28
Male reproductivef 20 (9.2) 55.90 ± 13.59
Length of time since diagnosis (year) < 1 125 (57.6) 52.87 ± 11.23 0.32 .810
1~ < 2 36 (16.6) 51.89 ± 7.54
2~ < 5 35 (16.1) 53.26 ± 11.21
≥ 5 21 (9.7) 54.71 ± 10.91
Type of treatment Chemotherapy 92 (42.4) 53.20 ± 10.59 0.49 .741
Radiation therapy 7 (3.2) 54.43 ± 12.49
Surgery 46 (21.2) 51.07 ± 10.97
Supportive care 61 (28.1) 53.72 ± 10.26
CCRT 11 (5.1) 53.55 ± 11.42
Disease status Early stagea 34 (15.7) 49.35 ± 11.09 5.08 .007 a < c
Treatment stageb 107 (49.3) 52.11 ± 10.50
Reccur/metac 76 (35.0) 55.74 ± 10.02
Sleep disruption* Yes 99 (45.6) 54.28 ± 10.23 1.70 .090
No 118 (54.4) 51.83 ± 10.86
Problem with eating/feeding* Yes 117 (53.9) 52.86 ± 10.13 - 0.13 .898
No 100 (46.1) 53.05 ± 11.23
Incontinence* Yes 43 (19.8) 55.42 ± 11.28 1.71 .089
No 174 (80.2) 52.34 ± 10.40
Confusion* Yes 65 (30.0) 57.12 ± 10.96 3.91 < .001
No 152 (70.0) 51.16 ± 10.00
Evidence of fall* Yes 36 (16.6) 56.56 ± 10.10 2.25 .025
No 181 (83.4) 52.23 ± 10.61
Skin breakdown* Yes 45 (20.7) 55.31 ± 11.51 1.68 .094
No 172 (79.3) 52.33 ± 10.33

ECOG PS=Eastern cooperative oncology group scale of performance status; CCRT=Concurrent chemoradiotherapy; *An overall assessment for older adults.

Table 3

cores of Perceived Health Status, Hope, Social Support and Burden (N=217)

aon-16-20-i003
Variables Possible range Min Max M±SD of item
Perceived health status 3~15 3 15 2.89±0.81
Hope 12~60 19 60 3.39±0.65
Social support 19~95 21 95 3.36±0.89
 Emotional/informational 8~40 8 40 3.38±0.86
 Tangible 4~20 4 20 3.16±1.05
 Affectionate 3~15 3 15 3.52±0.95
 Positive social interaction 4~20 4 20 3.38±0.98
Burden 17~85 28 81 3.11±0.63
 Disrupted schedule 5~25 8 25 3.62±0.66
 Financial problems 3~15 3 15 3.07±0.96
 Lack of family support 5~25 5 23 2.57±0.85
 Health problems 4~20 4 20 3.20±0.87
Table 4

Correlations among Perceived Health Status, Hope, Social Support and Burden (N=217)

aon-16-20-i004
Variables Perceived health status Hope Social support Burden
r (p) r (p) r (p) r (p)
Perceived health status 1
Hope .46 (<.001) 1
Social Support .38 (<.001) .65 (<.001) 1 - .48 (<.001)
 Emotional/informational .35 (<.001) .63 (<.001) - .57 (<.001)
 Tangible .38 (<.001) .57 (<.001) - .47 (<.001)
 Affectionate .35 (<.001) .60 (<.001) - .56 (<.001)
 Positive social interaction .36 (<.001) .66 (<.001)
Burden - .48 (<.001) - .60 (<.001) - .55 (<.001) 1
 Disrupted schedule - .27 (<.001) - .37 (<.001) - .34 (<.001)
 Financial problems - .26 (<.001) - .40 (<.001) - .37 (<.001)
 Lack of family support - .33 (<.001) - .50 (<.001) - .50 (<.001)
 Health problems - .59 (<.001) - .56 (<.001) - .44 (<.001)
Table 5

Factors Influencing Burden among Family Caregivers (N=217)

aon-16-20-i005
Variables Burden
B SE β t p Tolerance VIF Adj. R2
(Constant) 71.39 3.25 21.96 < .001
Hope - 0.36 0.08 - .27 - 4.81 < .001 .59 1.71 .36
Other caregivers* - 3.87 1.12 - .18 - 3.44 .001 .66 1.51 .47
PES† 5.37 1.12 .23 4.78 < .001 .80 1.25 .52
Caring time 0.21 0.06 .17 3.70 < .001 .86 1.16 .57
Gender‡ 3.05 1.10 .12 2.78 .006 .93 1.08 .58
Confusion§ 2.47 1.02 .11 2.42 .016 .93 1.08 .59
Tangible support - 0.34 0.15 - .14 - 2.32 .021 .53 1.88 .60
Perceived health status - 0.50 0.22 - .12 - 2.31 .022 .73 1.38 .61
Adj. R2=.61, F=43.15, p<.001

*Dummy variable: No=0, Yes=1; †Dummy variable: High=0, Low=1; ‡Dummy variable: Male=0, Female=1; §Dummy variable: No=0, Yes=1; PES=Perceived economic status.

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