Are Disagreements in Caregiver and Patient Assessment of Patient Health Associated with Increased Caregiver Burden in Caregivers of Older Adults with Cancer?
Are Disagreements in Caregiver and Patient Assessment of Patient Health Associated with Increased Caregiver Burden in Caregivers of Older Adults with Cancer?
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DOI：
10.1634/theoncologist.2017-0085
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发表时间：
2017-11-01
期刊：
影响因子：
5.8
通讯作者：
Hurria, Arti
中科院分区：
文献类型：
--
作者：
Hsu, Tina;Loscalzo, Matthew;Hurria, Arti
背景。随着患者年龄的增长，护理人员越来越多地提供必要的支持和患者信息。我们试图确定患者与护理人员对患者健康状况的评估是否存在差异，以及差异是否会增加患有癌症的老年人的护理人员的负担。材料和方法。 100 名年龄 >= 65 岁的患者及其护理人员独立评估了患者的功能、合并症、营养、社会活动、社会支持和心理健康。护理人员完成了护理人员压力指数 (CSI)。使用 Wilcoxon 符号秩检验和配对 t 检验对患者与护理人员的评估进行比较。使用广义线性回归检查护理人员负担与患者-护理人员评估之间的差异之间的关联。结果。患者中位年龄为 70 岁（范围 65-91 岁），70% 患有晚期疾病。 60% 的患者报告需要工具性日常生活活动 (IADL) 方面的帮助；大多数人拥有良好的社会支持（医疗结果研究 MOS]-社会支持调查中位数 92 分）和心理健康（心理健康量表中位数 85 分）。护理人员的中位年龄为 66 岁（范围 28-85 岁），其中 73% 为女性，68% 为配偶护理人员，79% 与患者住在一起。护理人员认为患者的身体机能较差（IADL 依赖性较高 [p = .008]、卡诺夫斯基表现状态较低 [p = .02]、MOS 身体功能较低 [p < .0001]）、心理健康状况较差（p = .0002），并且比患者本身拥有更多的社会支持（p = .03）。四分之三的护理人员经历了一些护理负担（平均 CSI 得分 3.1）。只有患者与护理人员对患者 IADL 帮助需求的评估差异与护理人员负担增加相关 (p = .03)。结论。患者与护理人员对患者功能、心理健康和社会支持的评估不同。然而，只有 IADL 依赖评估的差异与护理人员负担的增加相关。
Background. As patients age, caregivers increasingly provide essential support and patient information. We sought to determine if patient-caregiver assessments of patient health differ and if differences contribute to burden in caregivers of older adults with cancer.Materials and Methods. One hundred patients, aged >= 65, and their caregivers independently assessed patient function, comorbidity, nutrition, social activity, social support, and mental health. Caregivers completed the Caregiver Strain Index (CSI). Patient-caregiver assessments were compared using the Wilcoxon signed rank test and paired t test. Association between caregiver burden and differences between patient-caregiver assessments was examined using generalized linear regression.Results. Median patient age was 70 (range 65-91) and 70% had advanced disease. Sixty percent of patients reported requiring help with instrumental activities of daily living (IADLs); most had good social support (median Medical Outcomes Study MOS]-Social Support Survey score 92) and mental health (median Mental Health Inventory score 85).Caregivers were a median age of 66 (range 28-85), 73% female, 68% spousal caregivers, and 79% lived with the patient. Caregivers rated patients as having poorer physical function (more IADLs dependency [p = .008], lower Karnofsky Performance Status [p = .02], lower MOS-Physical Function [p < .0001]), poorer mental health (p = .0002), and having more social support (p = .03) than patients themselves. Three-quarters of caregivers experienced some caregiver burden (mean CSI score 3.1). Only differences in patient-caregiver assessment of the patient's need for help with IADLs were associated with increased caregiver burden (p = .03).Conclusion. Patient-caregiver assessments of patient function, mental health, and social support differ. However, only differences in assessment of IADLs dependency were associated with increased caregiver burden.