Health-Promoting Behaviors: A Measure of Caregiver Burden in the Cancer Setting

Health-promoting behaviors of the family caregivers of patients with cancer can be categorized into distinct classes, suggesting the opportunity for tailored interventions, according to research presented at the 47th Annual Oncology Nursing Society (ONS) Congress.

Cancer is the fourth leading reason for being a caregiver, and as of 2020, there is an estimated 47.9 million unpaid caregivers in the United States. Patients with cancer require more hours per week of caregiving with greater complexity of tasks, including help with activities of daily living, care coordination, and medical/nursing tasks. Caregivers experience increased levels of stress and psychological symptoms such as depression and anxiety, explained Hyojin Son, PhD, RN, post-doctoral fellow, Translational and Behavioral Health Disparities Branch, National Institute of Health Clinical Center in Bethesda, Maryland.

The burden of caregiving can lead to a disruption of healthy behaviors within the family. Caregivers of patients with cancer tend to prioritize the needs of the patient over their own and are less likely to practice health-promoting behaviors such as physical activity, healthy diet, and stress management.

Research on health-promoting behaviors among family caregivers has been limited. Prior studies often averaged the levels of health-promoting behavior into a single linear measure. Therefore, a team of nurse researchers from the National Institute of Health Clinical Center sought to determine whether patterns of health-promoting behaviors among caregivers can be classified, and whether caregiver characteristics such as perceived stress, caregiver burden, self-efficacy, and psychological factors can predict these behavior patterns.

This analysis was conducted using the datasets of 2 independent studies that examined health-promoting behaviors in family caregivers of patients who underwent cancer treatment at a national research hospital: a longitudinal survey study, with 129 participants, and a randomized controlled trial, with 50 participants. A model-based approach was used to cluster caregivers into distinctive groups (ie, latent classes) using multiple observed indicators.

Latent profile analysis (LPA) was performed to identify classes of health-promoting behaviors using the Health-Promoting Lifestyle Profile II. After identifying the classes of health-promoting behaviors, multinomial logistic regression analysis was conducted to determine factors predicting those classes. The identified caregiver characteristics were considered potential predictors.

Of 179 caregivers, 129 (72.1%) were female, 133 (74.7%) were White, 149 (83.7%) identified as non-Hispanic, and mean age was 47.6±12.88 years. Approximately half (87 [48.6%]) were the spouse or partner of the patient and 146 (82.0%) were married or partnered. Many caregivers were working (125 [69.8%]), and more than half (92 [56.4%]) reported an annual income of $70,000 or more. The caregivers had a body mass index of 27.4±5.67 kg/m² (range, 17.2 to 46.5) and 101 (56.7%) reported having a chronic health problem.

Three distinct latent classes of health-promoting behaviors were identified: low overall level (35 [21%]), moderate overall level (99 [56%]), and high overall level (40 [23%]). Controlling for age, sex, body mass index, and annual income, higher perceived stress, higher caregiving burden related to a lack of family support, and lower self-efficacy were risk factors for poorer levels of health-promoting behaviors, concluded Dr Son.

LPA was able to identify caregivers with lower levels of health-promoting behaviors. Nurses should look for stable patterns of health-promoting behaviors; providing support for one type of behavior (eg, healthy diet, exercise) could positively affect another type of behavior (eg, stress management).

Further research directions include larger samples and a longitudinal design, as well as mixed-method approach.

Read more of Oncology Nurse Advisor‘s coverage of the 47th Annual ONS Congress by visiting the conference page.

Reference

Son H, Wallen G, Cox R, et al. Patterns of health-promoting behaviors and associated factors in family caregivers of people with cancer: a latent profile analysis. Oral presentation at: 47th Annual ONS Congress; April 27-May 1, 2022; Anaheim, California.