Analysis of the Current Status and Influencing Factors of Caring Ability of Main Relatives and Caregivers of Patients with Esophageal Cancer ()
1. Introduction
Esophageal cancer, one of the common malignant tumors occurred in the digestive tract, is the eighth common cancer in the world and the sixth common cause of death [1], which the incidence and mortality in China are both the first in the world [2]. Surgical resection, one of the main treatments of esophageal cancer, involves multiple parts such as the thorax, abdomen and neck [3], but can cause a series of complications due to the complex anatomical structure of the esophagus itself and the high transfer rate of postoperative lymph nodes [4], such as postoperative malnutrition, anastomotic fistula, recurrent laryngeal nerve injury, lung infection, high recurrence rate and so on, which is a huge challenge to the family caregiver who takes care of the postoperative patients’ daily life. The family caregiver not only needs to know the nursing and first-aid knowledge related to disease, but also needs to balance the psychological burden and pressure of the patients and themselves, which is a serious challenge to the caring ability of the family caregiver. The caring ability is the ability of caregivers to maintain the health of the patients and themselves [5], which directly or indirectly affects the postoperative rehabilitation quality of the patients with esophageal cancer, so it deserves more attention and concern. This study intends to investigate the caring ability and influencing factors of the family caregiver of patients with esophageal cancer, explores its relationship with the caring burden, and provides a reference for effectively evaluating and improving the caring ability of caregivers.
2. Objects and Methods
2.1. Objects
According to the number of items of the relevant use scale, from May 2019 to May 2021, 290 radical postoperative patients with esophageal cancer and their family caregivers were selected as the objects by the convenience sampling method in a Class III Grade A tertiary tumor hospital in Guangzhou. And the questionnaire survey was taken. Inclusion criteria of patients: 1) The radical postoperative patients with esophageal cancer who is diagnosed in the histopathology; 2) The patients who are over 18 years old, conscious and able to communicate; 3) The patients whose esophageal cancer is primary lesion and non-metastatic; 4) The patients who are informed consent to this study and volunteered to participate in this study. Exclusion criteria: 1) The patients with mental disorder; 2) The patients unwilling to cooperate; 3) The patients with acute and critical diseases of other systems. Inclusion criteria of primary caregiver: 1) To be the main family caregiver of the patient (with the longest daily caring time, or identified by the patient in the case of multiple family caregivers); 2) The caregivers who are over 18 years old, conscious and able to cognitively communicate; 3) The patients who are informed consent to this study and volunteered to participate in this study. Exclusion criteria: 1) The person with mental disorders or cognitive abnormalities, who is unable to fill in the questionnaire; 2) The employed caregivers.
2.2. Tools
1) General data questionnaire
The questionnaire includes the patients’ age, gender, education level, marital status, medical payment mode, the length of stay and whether the complication occurs; family caregivers’ age, gender, relationship with patients, education level, marital status, residence, family monthly income, chronic disease, regular job and caring experience.
2) Family caregiver task inventory, FCTI
The FCTI, prepared by American scholar Clark et al. [6] in 1983 and translated and revised by numbers of scholars [7] [8] [9], is used to evaluate the tasks of patients’ family caregivers, getting extensive reliability and validity tests. The FCTI contains a total of 5 dimensions with 25 items, including learning and adapting to the role of caregivers (5), assistance provided as required by the patients (5), management of individual emotion (5), evaluation of the supporting resources of the family and the society (5), and balancing of the caregiving needs and the personal needs (5). Likert Level 3 scoring method is used in each item, in which no difficulty = 0, difficulty = 1, and high difficulty = 2. Total score of the FCTI is 0 - 50, and a higher score indicates a poorer level of caring ability. In this study, the Cronbach’s α coefficient of the FCTI is 0.932 and the test-retest reliability is 0.791.
2.3. Research Method
A cross-sectional survey was used in this study, and the researcher himself explained the survey objective and how to fill to the respondents with a unified guidance, distributed the questionnaires uniformly after informed consent, and retrieved the questionnaires on the spot after completing the filling. Check for any error or missing of filling, timely improve the questionnaire to ensure the integrity, guide the respondents who have doubts in time, but do not interfere with and or imply any filling. There are 298 pieces of questionnaire released in total, with 290 valid ones taken back at the effective rate of 97.3%.
2.4. Statistical Method
SPSS 25.0 software is used for statistical analysis, and the enumeration data are described with frequency and percentage. The normally distributed measurement data are described with
± s; the comparison among groups is analyzed by t test or single factor; and for multiple-factor analysis, multiple linear stepwise regression analysis applies. It is statistically significant if P is <0.05.
3. Results
3.1. Current Status of Caring Ability of Family Caregivers of Postoperative Patients with Esophageal Cancer
According to the results, the total average score of caring ability of family caregivers of postoperative patients with esophageal cancer was (32.99 ± 3.01), as shown in Table 1 for details.
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Table 1. Scores of caring ability of the family caregivers.
3.2. Single-Factor Analysis of Common Features and Caring Ability of the Family Caregivers of Postoperative Patients with Esophageal Cancer
According to the results, the ages of the patients range from 37 to 82 (61.47 ± 8.41) years old, and the ages of the family caregivers range from 23 to 71 (46.75 ± 12.98) years old in this study. The statistical difference (P < 0.05) is found by comparing the scores of the patients’ age, education level, length of stay and any complications, his/her caregivers’ age, education level, residence and have any chronic diseases, family income per capita, any stable job and experience of caring, as shown in Table 2 and Table 3 for details.
3.3. Multiple Stepwise Regression Analysis on Influencing Factors of Caring Ability of the Main Family Caregivers of Postoperative Patients with Esophageal Cancer
Multiple linear stepwise regression analysis is carried out through taking total FCTI score as a dependent variable and 10 variables with the statistical significance of single-factor analysis as independent variables. See the assignment methods of the independent variables in Table 4. The independent variables including the age of the caregiver, the length of stay, the family income per capita, and whether having the experience of caring enter a regression equation, as shown in Table 5 for details.
4. Conclusion
4.1. Caring Ability of Family Caregivers of Postoperative Patients with Esophageal Cancer to Be Improved
The total average score of caring ability of family caregivers of postoperative
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Table 2. Comparison on FCTI scores of patients with different features (n = 290).
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Table 3. Comparison on FCTI scores of caregivers with different features (n = 290).
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Table 4. Assignment of independent variables.
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Table 5. Multiple linear regression analysis of influencing factors of caring ability of family caregivers (n = 290).
Note: F = 16.652, R2 = 0.235, Adjustment R2 = 0.227, P < 0.001.
patients with esophageal cancer was (32.99 ± 3.01), and the overall scoring rate is 65.9%, which are consistent with the research, made by Lyu Lulu, et al. [10], about the comprehensive caring ability of the main relatives of patients with cerebral stroke. The reasons are analyzed as follows: most patients with esophageal cancer are middle and old aged men, and most family caregivers are female, which are consistent with the study results of Wen Ziye, et al. [11]. Caregivers cannot master all nursing knowledge of esophageal cancer due to variety and complicatedness. In addition, the patient after the operation needs to be continuously nursed when going home, especially systematic learning is needed for nursing a parenteral nutritional canal during a fasting period; however, the education level of most relatives is relatively low, most relatives are poor in receptivity, do not have fixed time and do not care the patients systematically, as a result, the caring ability is relatively low on the whole. The scores, from high to low, of FCTI in all dimensions are described as follows: management of individual emotion, evaluation of the supporting resources of the family and the society, balancing of the caregiving needs and the personal needs, assistance provided as required by the patients, and learning and adapting to the role of caregivers, indicating that the caregiver is the poorest in the management of individual emotion, which is probably because that the caregiver feels stressed, nervous, anxious and the like after long-time caregiving. During the process getting along with the patient, some emotional changes of the patient can also affect the personal emotion of the caregiver; in the aspects of evaluation of the supporting resources of the family and the society, and balancing of the caregiving needs and the personal needs, the caring ability of the caregiver who is jobless or has low household income is relatively low, which is probably because that cancer needs support from all aspects and the caregiver cannot balance all needs; and in the aspects of learning and adapting to the role of caregivers, and assistance provided as required by the patients, most caregivers cannot adapt to the role from the beginning, and as time goes by, the caregivers gradually adapt to their roles and can provide assistances in multiple aspects [12] [13] [14]. It indicates that the medical staff should provide targeted assistance and psychological support for the caregivers, enhance the household nursing training of the patients with esophageal cancer after operation for the caregivers, effectively improve the sense of self-support of the caregivers, advocate the patient to establish the response plan of household nursing, and take the improvement of the life quality of the patient oriented.
4.2. Analysis of Influencing Factors of Caring Ability of Family Caregivers of Postoperative Patients with Esophageal Cancer
4.2.1. Age of the Caregivers
According to the study, the caring ability and the age of the caregiver are inversely correlated, that is, the younger the caregiver is, the higher the caring ability is. According to the study, the caregivers at the age of 60 or above account for 24.8%, wherein most caregivers also suffer from chronic diseases and lack energy and strength; however, postoperative patients with esophageal cancer carry multiple catheters and the caring details are tedious, so that the caregivers need to master related knowledge and skills. The elder caregivers always feel powerless to further affect personal emotions, as a result, most caregivers feel anxious and helpless. The study result is the same with Wei Shuna, et al. [15]. According to certain study [16], the caring burden of the caregivers is obviously increased when the caring time exceeds 12 hours, as a result, the caring ability and the caring quality are affected. It indicates that we shall attach great importance to personal factors of the caregivers, help them ease and manage negative emotion, improve the response ability of the caregivers, and comprehensively improve the caring ability of the caregivers from multiple aspects.
4.2.2. Length of Stay
According to the study, the caring ability of the relatives of patients who are in hospital for a long time is higher. Most postoperative patients with esophageal cancer need to fast for more than two weeks. The time for starting feeding is determined according to the growth condition of an incision. Most patients need household enteral nutrition for a period of time even if they leave hospital, which indicates that the caregivers need to continuously look after the patients. With the accumulation of time and experience, the caregivers gradually master disease knowledge and nursing skills. In addition, according to this study, the patients having post-operative complications account for 67.9%. Long-time in-hospital supporting caring enables the caregivers to systematically learn the caring contents and the caregivers gradually form their caring modes.
4.2.3. Household Incomes Per Capita
According to the study result, the caring ability of the caregiver with high household incomes per capita is the highest, followed by the caring ability of the caregiver with medium household incomes per capita, and the caring ability of the caregiver with low household incomes per capita is the lowest. The economic burden has a huge impact on the treatment and recovery of the patient and also causes high and low caring pressure of the caregiver. The study result of Yi Lina, et al. [17] indicates that most caregivers will face the economic burden during the caring. Some caregivers who have a tight life not only undertake high treatment and nursing cost and sometimes also need to pay lost wage, nutrition fee and other economic costs generated by diseases. The economic limitation enables the caregivers to feel more powerless when they care the patients. The incapacity of meeting the material needs and psychological needs of the patients may probably enable the caregivers to lose caring confidence, as a result, the caring ability of the caregivers is reduced. This suggests that when caring for patients and relatives with poor family financial status, we should help them seek more social support, provide nursing guidance in conjunction with community health care, cut unnecessary treatments and medications, and try to save medical costs while not affecting the patient’s recovery. Most importantly, we should promote the improvement of medical insurance. More expensive treatments and high-priced drugs should be included in medical insurance reimbursement. Targeted guidance and assistance should be provided to those families with cancer patients who have difficulties in caring for them by the community, so as to effectively improve the quality of patients’ recovery and enhance the caregivers’ caring ability.
4.2.4. Availability of Caring Experience
This study showed that caregivers with previous caring experience had high ability scores, which is consistent with the findings of Sun et al. [18] in stroke patients. Those experience caregivers have a high level of knowledge and application related to esophageal cancer, and a better capacity to both seek medical resources and guide rehabilitation. Therefore, this suggests that health care workers should identify caregivers with low caring ability at an early stage. Especially for those who are aged, poorly educated, and lack caring experience, they should develop targeted caring intervention programs to help caregivers learn more knowledge and skills, provide more communication and emotional support, improve their capacity, and train caregivers to do their job more professionally.
5. Conclusion
This study showed that the ability of primary family caregivers to care for postoperative patients with esophageal cancer is obviously insufficient. The factors for caregivers’ ability include their per capita family income, availability of caring experience, and level of caring burden. Health care workers should pay more attention to the caring ability for primary family caregivers of patients with postoperative esophageal cancer, and provide targeted knowledge and emotional support to enhance their caring ability and effectively improve patients’ postoperative recovery and quality of life. In this study, most of the subjects were female, and most of the caregivers were middle-aged or elderly. A large number of the caregivers had low education levels. The sample characteristics were limited due to the lack of a sample of young caregivers, and the scope of this study only involved a tertiary oncology hospital and did not include community outpatient clinics. Therefore, the sample was not highly representative, and the later study is expected to make up for the shortcomings in order to obtain more objective and comprehensive research data.
NOTES
*Weijing Wei and Dandan Liu are the co-first authors.
#Corresponding authors.