Caregiving burden and health-promoting behaviors among the family caregivers of cancer patients

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Abstract

Purpose

The role of family caregivers in cancer care continues to expand, and it has been suggested that the caregiving influences health-promoting behaviors. The purpose was to describe the caregiving burden and health-promoting behaviors of the family caregivers of cancer patients and to determine the relationship between caregiving burden and health-promoting behaviors.

Method

A cross-sectional descriptive study was conducted involving 227 family caregivers of adult cancer patients. Caregiving burden was measured using the Korean version of the Zarit Burden Interview (K-ZBI), and health-promoting behaviors were determined using structured questionnaires.

Results

Considerable burden was experienced by the caregivers of cancer patients (K-ZBI score of 36.51 ± 12.54, mean ± SD). However, caregiving burden did not influence caregivers' physical activity, diet, smoking, alcohol consumption, or adherence to cancer screening tests. When the caregivers were compared to controls from the Korea National Health and Nutrition Examination Survey V utilizing adjusted proportions, caregivers were less likely to perform physical activities (16.0% vs. 29.1%, p < 0.001), but more likely to adhere to alcohol consumption recommendations (76.3% vs. 35.0%, p < 0.001) and receive cancer screening services for stomach (68.5% vs. 56.8%, p < 0.011), breast (81.4% vs. 58.8%, p < 0.001), and cervical cancer (75.3% vs. 55.0%, p < 0.001).

Conclusions

The caregivers of cancer patients reported considerable caregiving burden. However the burden was not associated with health-promoting behaviors. Physical inactivity among caregivers may require interventions to promote health of caregivers.

Implications for practice

Relieving caregiving burden and improving caregivers' physical activities need to be considered as separate care issues in planning interventions for caregivers of cancer patients.

Introduction

The burden of cancer continues to increase: 14 million new cases were estimated per year in 2012 worldwide, and the figure is expected to rise to 22 million annually over the next two decades (International Agency for Research on Cancer, 2014). It is predicted that 36.4% of Koreans will develop cancer in their lifetime (Korea Central Cancer Registry, 2011). Family members become caregivers at the time of cancer diagnosis, and accompany the patient on their journey to cancer survivorship. Family caregivers become responsible for many elements of cancer care, such as scheduling visits, providing accommodation, monitoring treatment compliance, symptom management, emotional support, meal preparation, housekeeping, and providing financial support (Given et al., 2001, Stenberg et al., 2010), but this usually occurs with insufficient preparation or training in the provision of care. Caregivers often neglect their own needs, and are even often required to give up their usual daily activities due to their caregiving responsibilities (Beesley et al., 2011, Molassiotis et al., 2011). These efforts to care for their loved ones burden family caregivers.

The caregiving burden experienced by the caregivers of cancer patients is as high as that of caregivers to those with dementia (Kim and Schulz, 2008). Caregivers experience various types of burden; including physical (Fletcher et al., 2008, Osse et al., 2006, Stenberg et al., 2010), psychosocial (Braun et al., 2007, Deshields et al., 2012, Grunfeld et al., 2004, Osse et al., 2006, Song et al., 2011, Stenberg et al., 2010, Williams and McCorkle, 2011), and financial burden (Deshields et al., 2012, Song et al., 2011, Yun et al., 2005). Performing caregiving is known to influence the health-promoting behaviors of caregivers. Less-than-optimal physical activities were attributable to their caregiving (Beesley et al., 2011, Mazanec et al., 2011). The physical health of family caregivers of lung cancer patients was shown to deteriorate as a result of their caregiving responsibilities (Milbury et al., 2013, Mosher et al., 2013). They also had issues regarding their diet, such as consuming less-than-optimal amounts of fruit and vegetables (Beesley et al., 2011). Chronic diseases were more prevalent among caregivers, most commonly hypertension and arthritis (Mazanec et al., 2011). Caregiving responsibilities lead caregivers to forget to take medications and even prevent them from seeing a doctor when they need to, or delay getting a medical test or screening (Burton et al., 2012, Mazanec et al., 2011).

It was hypothesized that caregiving burden would negatively influence caregivers' health-promoting behaviors (i.e., primary prevention behaviors such as physical activity, healthy diet, no smoking, and consuming adequate amount of alcohol; secondary prevention behaviors such as receiving cancer screening tests; tertiary prevention behaviors such as managing chronic disease). However, the relationship between the burden and three levels of health-promoting among caregivers of cancer patients has not been reported previously. A comprehensive understanding of caregiving burden and its relationship with health-promoting behaviors among caregivers of cancer patients would provide helpful information regarding the issues that they face and enable the planning of care for caregivers as recipients of care.

The purpose of this study was to describe the caregiving burden and health-promoting behaviors of family caregivers of cancer patients and to determine the relationship between caregiving burden and health-promoting behaviors among these caregivers.

Section snippets

Design

A cross-sectional survey was conducted for this descriptive study.

Sample

A total of 227 family caregivers of 226 adult cancer patients receiving care at 2 university hospitals located in Seoul and Daejeon in Korea participated in this study. There were two caregivers of one cancer patient who reported equally sharing caregiving responsibility, thus both were considered as main caregivers. Data were collected between August 2012 and January 2013. The inclusion criteria were (1) being a family caregiver

General characteristics: caregivers

The 227 included caregivers were middle aged (46.6 ± 11.98 years, mean ± SD; range 20–75 years), mostly female (80.6%), and residing with the patients (69.6%). Most of the caregivers were immediate family members of patients (i.e., spouse or offspring; 84.6%), with spouses comprising the majority. Many caregivers had the sole caregiving responsibility (65.6%), and 65.8% of the sole caregivers were spouses. The caregivers were highly educated (79.7% had achieved more than high-school education),

Discussion

Considerable caregiving burden was experienced by primary caregivers in this study. The level of burden was similar to that of caregivers of cancer patients in the Papastavrou et al. (2009) study, whose ZBI score was reported as 37.0 ± 16.0. In a study of the educational support for the caregivers of cancer patients (Belgacem et al., 2013), caregivers who did not receive educational intervention reported a ZBI score of 31.4 ± 14.9. Considering the low burden score of 16.0 ± 9.9 among those who

Conclusion

Caregivers of cancer patients appear to experience a considerable caregiving burden. However, the caregiving burden per se did not contribute the issues observed related to health-promoting behaviors. Caregivers were less likely to meet physical activity recommendations, however, more caregivers were adhering to alcohol consumption recommendations, and receive stomach, breast and cervical cancer screening services. Caregiving burden and health-promotion needs to be considered as separate issues

Conflict of interest

None.

Acknowledgement

This research was supported, in part, by the 2012 Eulji Univerisity Research Grant, in part, by the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education, Science, and Technology (2012010107), and in part, by the Public Welfare & Safety Research Program through the National Research Foundation of Korea, funded by the Ministry of Science, ICT & Future Planning (2010-0020841).

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