Onkolojik Palyatif Bakım Servisi’nde Yatan Hastaların Bakımını Üstlenen Bireylerin Algılanan Stres Düzeyleri ve Strese Etki Eden Faktörlerin Belirlenmesi: Kesitsel Bir Çalışma

Year 2020, , 227 - 235, 04.06.2020

Arzu Ayraler , Selçuk Akturan , Gökhan Kumlu

https://doi.org/10.18521/ktd.638711

Cited By: 1

Abstract

Amaç: Dünya Sağlık Örgütü palyatif bakım ile hastaların fiziksel şikayetlerine yönelik destek tedavilerinin yanında psikososyal ve manevi sorunlarının giderilmesi, aynı zamanda ailenin ve bakım verenlerin de desteklenmesini hedefler. Palyatif bakım hastalarına bakım verenlerde, strese uzun süre maruz kaldıklarından çeşitli sağlık sorunları, işlev kayıpları gelişmekte ve hayat kaliteleri de olumsuz yönde etkilenmektedir. Çalışmadaki amacımız Palyatif Bakım Servisi’nde yatan hastaların bakımını üstlenen bireylerin stres algılarını ölçmek, stres düzeyini etkileyebilecek sosyo-kültürel ve sağlığa yönelik özelliklerini ortaya çıkarmaktır.

Yöntem: Araştırma tanımlayıcı, kesitsel bir anket çalışmasıdır. Araştırmanın evreni 1 Şubat 2019 ile 1 Mayıs 2019 tarihleri arasında Palyatif Bakım Servisi’nde yatan hastaların bakımlarını üstlenen bireylerdir. Katılımcılara; kişinin sosyo-kültürel özelliklerini, sağlık durumlarını, bakımını üstlendiği hastanın hastalık geçmişine yönelik soruları içeren anket formu uygulanmıştır.  Ayrıca, katılımcılara stres düzeylerini ölçen ‘Algılanan Stres Ölçeği-10’ da uygulanmıştır.

Bulgular: Katılımcıların %61.25’i kadın, %38,75’i erkekti. Bakıcı bireylerin %41,25’ini hastaların eşi ve çocukları oluşturmaktaydı. Hastalarının şimdiye kadar toplamda hastane yatışı günü 21±6,74 olduğu belirlenmiştir. Hastasına daha önce evde veya hastane dışı bir ortamda bakanların oranının %21 olduğu, bu süreçte karşılaştıkları en önemli sorunlar ise; hasta bakımına ilişkin sorunlar, hastalığa ait şikayetler ve tükenmişlik olduğu saptanmıştır. Hasta bakıcı bireylerde en sık görülen kronik hastalıklar; diyabet (%13,20), hipertansiyon (%12.26), depresyon (%10,37) olarak belirlenmiştir. Kronik hastalıklarının kontrol altında olduğunu düşünen bireylerin oranı %55.8’di. Algılanan Stres Ölçeği ortalama puanı 21,09±6,74 idi.

Sonuç: Palyatif bakım servisinde yatan hastaların bakımını üstlenenler, bakım süreçlerinde birçok sorunla karşılaştıklarını belirtmişlerdir. Hasta bakımında rol alan bireylerde depresyon tanısının normal popülasyondan daha fazla olduğu saptanmıştır. Hasta bakımını üstlenen bireylere psikososyal destek verilmesinin gerekliliği görülmektedir.

Keywords

bakıcılar, palyatif bakım, stres, psikolojik

Determination of Perceived Stress Levels of Caregivers of Inpatients in Oncologic Palliative Care Service and Factors Affecting Stress: A Cross-sectional Study

Abstract

Objective: The World Health Organization aims to support the psychosocial problems of the palliative care patient and the treatment of his physical complaints, as well as to support his family and caregivers. Since the caregivers of palliative patients are exposed to stress for a long time, various health problems and functional losses develop, and their quality of life is adversely affected. The aim is to measure the perception of stress of caregivers in Palliative Care Service (PCS) and to reveal socio-cultural and health-related characteristics.

Methods: This is a descriptive, cross-sectional study. The population of study was caregivers of patients in the PCS between 1 February 2019 and 1 May 2019. A questionnaire including questions about their health status, their patients’ history,  socio-cultural and demographic characteristics was applied. Also, Perceived Stress Scale-10 (PSS-10) measures perceived stress levels was applied.

Results: 61.25% of the participants were female and 38.75% were male. 41.25% of the caregivers consisted of the spouses and children of the patients. It was determined that the mean of hospitalization day of the patients was 21±6.74 . The rate of care at home or in an out-of-hospital setting were 21%. The most important problems faced were; problems related to patient care, complaints and burnout. The most common chronic diseases in caregivers were; diabetes (13.20%), hypertension (12.26%), depression (10.37%). The rate of thought that their chronic diseases were under control was 55.8%. The mean score of the PSS-10 was 21.09±6.74 .

Conclusion: The caregivers of patients in the palliative care service stated that they faced many problems in the care process. The diagnosis of depression was found to be higher in participants taking part in patient care than the normal population. Psychosocial support should be given to the caregivers.

Keywords

caregivers, palliative care, stress, psychological

References

• 1- World Health Organization. WHO definition of palliative care. Available from: http://www.who.int/cancer/palliative/definition/en/. Accessed: 02/05/19.
• 2- Sherman DW, McGuire DB, Free D, Cheon JY. A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage. 2014;48:385–99. e382.
• 3- Lund L, Ross L, Petersen MA, Groenvold M. Cancer caregiving tasks and consequences and their associations with caregiver status and the caregiver’s relationship to the patient: a survey. BMC Cancer. 2014;14:541.
• 4- De Korte-Verhoef MC, Pasman HR, Schweitzer BP, et al. Burden for family carers at the end of life; a mixed-method study of the perspectives of family carers and GPs. BMC Palliat Care. 2014;13:16.
• 5- Kulkarni P, Ghooi R, Bhatwadekar M, Thatte N, Anavkar V. Stress among care givers: the impact of nursing a relative with cancer. Indian J Palliat Care. 2014;20:31–9.
• 6- Rösler-Schidlack B, Stummer H, Ostermann H. Health-related quality of life of family caregivers - evidence from Hesse. J Public Health. 2011;19:269–80.
• 7- Cavers D, Hacking B, Erridge SE, et al. Social, psychological and existential well-being in patients with glioma and their caregivers: a qualitative study. CMAJ. 2012;184:E373–382.
• 8- Krug et al. Correlation between patient quality of life in palliative care and burden of their family caregivers: a prospective observational cohort study. BMC Palliative Care. 2016;15:4.
• 9- Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annual Review of Clinical Psychology. 2005;1: 607-628.
• 10- Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annual Review of Public Health. 2005. 26: 469-500.
• 11- Hammen C. Stress and depression. Annual Review of Clinical Psychology. 2005; 1: 293-319.
• 12- Cohen, S, Kamarck, T, Mermelstein R. A global measure of perceived stress. Journal of Health and Social Behavior.1983;24:385-96.
• 13- Kaya C, Tansey TN, Melekoglu M, Cakiroglu O, Chan F. Psychometric evaluation of Turkish version of the Perceived Stress Scale with Turkish college students, Journal of Mental Health. 2019;28(2):161-7. DOI: 10.1080/09638237.2017.1417566
• 14- Orucu M, Demir A. Psychometric evaluation of perceived stress scale for Turkish university students. Stress Health. 2009;25:103–9.
• 15- Türkiye Büyük Millet Meclisi (TBMM) (2010) Kanser Hastalığı Konusunun Araştırılarak Gereken Önlemlerin Belirlenmesi Amacıyla Kurulan Meclis Araştırması Komisyonu Raporu. (Rapor No: TBMM: 648). Ankara. Türkiye Büyük Millet Meclisi.
• 16- Özgul N, Gültekin M, Koç O, et al. Turkish community-based palliative care model: a unique design. Annals of Oncology. 2012; 23(3): 76-8.
• 17- Şahan FU, Terzioğlı F. Dünyada ve Türkı̇ye’de Palyatı̇f Bakım Eğitimi ve Örgütlenmesı̇, Cumhuriyet Hemşirelik Dergisi. 2015;4(2): 81-90.
• 18- Palyatif Bakım Merkezlerinin Mevcut Durumu. https://khgmozellikli.saglik.gov.tr/svg/palyatif.php Erişim tarihi 10 Eylül 2019
• 19- T.C. Sağlık Bakanlığı, Giresun Il Saglik Mudurlugu. https://giresuneah.saglik.gov.tr/TR,22197/palyatif-bakim-unitesi.html Erişim tarihi 2 Eylül 2019
• 20- Keir ST, Guill AB, Carter KE, et al. Differential levels of stress in caregivers of brain tumor patients-observations from a pilot study. Support Care Cancer. 2006;14(12):1258-61.
• 21- Cameron JI, Franche RL, Cheung AM, Stewart DE. Lifestyle interference and emotional distress in family caregivers of advanced cancer patients. Cancer. 2002;94(2):521-527.
• 22- Goldstein NE, Concato J, Fried TR, et al. Factors associated with caregiver burden among caregivers of terminally ill patients with cancer. J Palliat Care. 2004;20(1):38-43.
• 23- Ullrich A, Ascherfeld L, Marx G. Quality of life, psychological burden, needs, and satisfaction during specialized inpatient palliative care in family caregivers of advanced cancer patients. BMC Palliative Care. 2017;16:31. DOI 10.1186/s12904-017-0206-z
• 24- Aoun S, Slatyer S, Deas K, et al. Family Caregiver Participation in Palliative Care Research: Challenging the Myth. Journal of Pain and Symptom Management. 2017;53:851-61.
• 25- Queller DC. Why do females care more than males?. Proc. R. Soc. Lond. B. 1997;264:1555-57.
• 26- Goldsmith J, Ragan SL. Palliative Care and the Family Caregiver: Trading Mutual Pretense (Empathy) for a Sustained Gaze (Compassion). Behav. Sci. 2017;7(19) doi:10.3390/bs7020019
• 27- Egici MT, Can MK, Toprak D, Ozturk GZ, et al. Care Burden and Burnout Status of Caregivers Whose Patients are Treated in Palliative Care Centers. JAREN. 2019;5(2):123-131. doi:10.5222/jaren.2019.38247
• 28- Velosoa VI, Tripodoro VA. Caregivers burden in palliative care patients: a problem to tackle. Curr Opin Support Palliat Care. 2016;10:330-5.DOI:10.1097/SPC.0000000000000239
• 29- Choi S, Seo J. Analysis of caregiver burden in palliative care: An integrated review. Nurs Forum. 2019;1-11. DOI: 10.1111/nuf.12328
• 30- Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721–30.
• 31- Costantini M, Higginson IJ, Boni L, et al. Effect of a palliative home care team on hospital admissions among patients with advanced cancer. Palliat Med. 2003;17:315–21.
• 32- Lee YJ, Yang JH, Lee JW, et al. Association between the duration of palliative care service and survival in terminal cancer patients. Support Care Cancer. 2015;23:1057–62. DOI 10.1007/s00520-014-2444-4
• 33- Ciałkowska-Rysz AD, Pokropska W, Łuczak J, et al. How much does care in palliative care wards cost in Poland. Arch Med Sci, 2016;12(2): 457-68. DOI: 10.5114/aoms.2016.59272
• 34- Bennett MI, Ziegler L, Allsop M, et al. What determines duration of palliative care before death for patients with advanced disease? A retrospective cohort study of community and hospital palliative care provision in a large UK city. BMJ Open. 2016;6:e012576. doi:10.1136/bmjopen-2016 012576
• 35- Pottie CG, Burch KA, Thomas LPM, Irwin SA. Informal Caregiving of Hospice Patients. Journal of Palliative Medicine. 2014;17(7). DOI: 10.1089/jpm.2013.0196
• 36- Schumacher KL, Stewart BJ, Archbold PG, et al. Effects of caregiving demand, mutuality, and preparedness on family caregiver outcomes during cancer treatment. Oncol. Nurs. Forum. 2008;35:49–56.
• 37- Schumacher KL, Stewart BJ, Archbold PG. Mutuality and preparedness moderate the effects of caregiving demand on cancer family caregiver outcomes. Nurs. Res. 2007;56: 425–33.
• 38- Hoffman GJ, Lee J, Mendez-Luck CA. Health behaviors among baby boomer informal caregivers. Gerontologist. 2012;52(2):219-30.
• 39- Kim H, Chang M, Rose K, Kim S. Predictors of caregiver burden in caregivers of individuals with dementia. J Adv Nurs. 2012;68(4):846-55.
• 40- Rodakowski J, Skidmore ER, Rogers JC, Schulz R. Role of social support in predicting caregiver burden. Arch Phys Med Rehabil. 2012;93(12):2229- 36.
• 41- Adelman RD, Tmanova LL, Delgado D, et al. Caregiver Burden. JAMA. 2014;311(10):1052. doi:10.1001/jama.2014.304
• 42- Kim SH, Hwang IC, Ko KD, et al. Association between the emotional status of the family caregiver and length of stay in a palliative care unit: a retrospective study. Palliat Support Care. 2015;13:1695–1700.
• 43- O’Connor EA, Whitlock EP, Beil T.L, Gaynes BN. Screening for depression in adult patients in primary care settings: a systematic evidence review. Ann Intern Med. 2009;151:793-803.
• 44- Erol N, Kılıç C, Ulusoy M. Türkiye Ruh Sağlığı Profili Raporu. Ankara 1998. Eksen Tanıtım Ltd.Şti.
• 45- Türkiye Halk Saglığı Kurumu (THKS). Türkiye Kronik Hastalıklar ve Risk Faktörleri Sıklıgı Çalışması. 2013 Refik Saydam Hıfzıssıhha Merkezi Başkanlığı, Hıfzıssıha Mektebi Müdürlügü
• 46- Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, et al; TURDEP-II Study Group. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013 Feb;28(2):169-80. doi: 10.1007/s10654-013-9771-5.
• 47- Chrousos GP. Stress and disorders of the stress system. Nat. Rev. Endocrinol. 2009;5: 374–81. doi:10.1038/nrendo.2009.106.
• 48- Kneipp SM, Kairalla FJA, Stacciarini JMR, Pereira D, Miller MD. Comparison of Depressive Symptom Severity Scores in Low Income Women. Nurs Res. 2010 ;59(6): 380–88. doi:10.1097/NNR.0b013e3181f84ee9
• 49- Oken BO, Fonareva I, Wahbeh H. Stress-related cognitive dysfunction in dementia caregivers. J Geriatr Psychiatry Neurol. 2011 December;24(4): 191–8. doi:10.1177/0891988711422524.
• 50- Keir S. T, Farland M. M, Lipp E. S, Friedman H. S. Family Appraisal of Caregiving in a Brain Cancer Model. Journal of Hospice & Palliative Nursing. 2009;11(1):60–6. doi:10.1097/njh.0b013e3181917e35