基于结构方程模型的晚期癌症患者照料者疲劳感影响因素分析

Path analysis of influence factors of fatigue for caregivers of terminal cancer inpatients

摘要:

目的 探究影响晚期癌症住院患者照料者疲劳感的作用机制。方法 采用焦虑自评量表（SAS）、抑郁自评量表（SDS）、照料者压力量表（CBI）及疲劳评估量表（FAI），对65 例晚期癌症患者照料者进行问卷调查，运用路径分析探讨各因素影响疲劳的途径。结果 本次研究对象的疲劳平均得分4.79，其中76.9% 的照料者有轻度及以上疲劳。各因素对照料者疲劳感的影响符合中介模型（χ2/df=1.283，GFI=0.916，IFI=0.972，CFI=0.971，RMSEA=0.066），焦虑对疲劳的中介效应（P <0.05），其中压力的中介贡献率为100% ； 抑郁对疲劳的中介效应（P <0.05），其中压力的中介贡献率为22.8% ；其他共同照料者人数对疲劳的中介效应（P <0.05），其中压力的中介贡献率为27.8%。结论 大部分住院癌症晚期患者照料者均有轻度及以上疲劳。照料者的焦虑完全通过压力间接影响其疲劳感；抑郁和其他共同照料者人数部分通过压力间接影响疲劳感。针对影响照料者疲劳的因素，应积极开展适当、有效的干预，以缓解其疲劳感，促进身心健康及生存质量，以便能对患者有更好照顾。

Abstract:

Objective To study the mechanism of fatigue for terminal cancer inpatients’ caregivers. Methods Self-rating Anxiety Scale, Self-rating Depression Scale, Caregiver Burden Inventory, and Fatigue Assessment Instrument were used in questionnaire survey for 65 caregivers of terminal cancer patients. Path analysis was used to explore the pathways of factors affecting fatigue of terminal cancer inpatients’ caregivers. Results The average score of fatigue for participants was 4.79, 76.9% of the caregivers had mild and more severe fatigue. The influence of each factor on fatigue of terminal cancer patients’ caregivers accorded with completely-mediated model (χ2/df =1.283, GFI = 0.916, IFI = 0.972, CFI = 0.971, RMSEA = 0.066). The mediator effect of stress for anxiety on fatigue was statistically significant (P < 0.05), the mediator contribution rate of stress was 100%; the mediator effect of depression on fatigue was statistically significant (P < 0.05), the mediation contribution rate of stress was 22.8%; the mediator effect of the number of other co-caregivers on fatigue was statistically significant (P < 0.05), the mediation contribution rate of stress was 27.8%. Conclusions Most of the terminal cancer patients’ caregivers have mild and more severe fatigue. The anxiety of caregivers indirectly affects their fatigue completely through stress. Depression and the number of other co-caregivers indirectly affect fatigue partly through stress. For factors affecting fatigue of caregivers, appropriate effective intervention should be actively carried out to relieve their fatigue, promote physical and mental health and survival quality, so that they can better take care of the patients.