Prevalence and Correlates of Caregiver Anxiety in Family Caregivers of Patients With Advanced Cancer: a Cross-Sectional Study in a Palliative Care Unit in Hong Kong

Abstract

Objectives: To assess the prevalence of caregiver anxiety and to identify correlates of caregiver anxiety in family caregivers of patients with advanced cancer in a palliative care unit in Hong Kong. Methods: Family caregivers of patients admitted to the palliative care ward for the first time between July 2019 and September 2019 were screened for recruitment. Caregiver demographics (age, sex, marital status, occupation, education level, housing condition, relationship with the patient, known diagnosis of anxiety or depression, and Charlson comorbidity index) were collected, as were caregiver understanding of patient’s diagnosis and prognosis, perceived patient’s distress, frequency of witnessing confusion or delirium of patients in past month, perceived adequacy of psychological support (other than general social support), and perceived anxiety towards patient’s approaching death. Caregiver anxiety was assessed using the 7-item Generalised Anxiety Disorder scale (GAD-7). Caregiver depression status was assessed using the 9-item Patient Health Questionnaire (PHQ-9). Caregiver psychological well-being was assessed using the 11-item Psychological Well-being Scale for Family Caregivers (PWS-C). Caregiver overall burden was assessed using the Chinese version of the 13-item Modified Caregiver Strain Index (C-M-CSI). Results: 70 caregivers (of 66 patients) were included, with a response rate of 98.6%. 16 (22.9%) caregivers had moderate to severe anxiety (GAD-7 score of ≥10). The GAD-7 score was higher in female caregivers than in male caregivers (mean rank: 39.26 vs 27.83, p = 0.026). 26 (37.1%) caregivers had depression (PHQ-9 score of ≥7). The GAD-7 score of caregivers was associated with the PHQ-9 score (rs = 0.834, p < 0.01), the four subscales of PWS-C: social support (rs = -0.308, p = 0.01), life meaning (rs = -3.30, p < 0.01), emotional distress (rs = 0.615, p < 0.01), and caregiver inadequacy (rs = 0.41, p < 0.01), and the C-M-CSI score for caregiver overall burden (rs = 0.332, p < 0.01). In multiple linear regression, predictors for GAD-7 score were the PHQ-9 score, caregiver’s feeling of anxiety towards patient’s approaching death, and caregiver sex. Conclusions: 22.9% of family caregivers of patients with advanced cancer have moderate to severe anxiety. Anxiety of caregivers was associated with depression, caregiver’s feeling of anxiety towards patient’s approaching death, psychological support, and life meaning. All these are potentially amendable by interventions. A structured screening of anxiety in family caregivers of patients with advanced cancer should be considered as routine practice.