How to Address Caregiver Burden, Psychological Resilience and One's Health

It is important for caregivers of patients with cancer to seek interventions that address burden and help to improve psychological resilience and self-rated health, according to researchers from the University of Colorado Denver.

It is known that providing care for a loved one with cancer can also have a toll on one’s own health — physical and emotional.

CURE spoke with study authors Matthew Golub BS, BA, and David Avram about the implications of these results.

“It is important to understand the effects that a cancer diagnosis can have on a caregiver because a caregiver, more now than ever, is an integral part of providing care to patients with cancer, especially as treatment has advanced and changed over the last couple of decades, a lot more care is being administered in informal settings at home for instance,” Avram said.

Burden, Resilience and Self-Rating

Self-rated help — also known as self-reported health, self-assessed health or perceived health – is simply one question that an individual rates their health based on a five-point scale: poor, fair, good, very good and excellent.

“We’re really just asking folks how to rate their health,” Avram explained. “It is a really important variable and (answers the question): Are people able to assess their health in a way that they are tapping into an understanding of their health that is not completely captured by objective indicators of health (like blood pressure readings, cholesterol or disease statuses).”

In this study, the researchers evaluated psychological resilience — which is essentially the ability to successfully cope with a crisis.

“One of the things that I find interesting about it is that psychological resilience is a lot more nuanced than the absence of disease. … It is this holistic, broad construct that is over and above things more simply like depression and anxiety, for instance, as predictors of health or outcomes,” explained Avram.

“So, psychological resilience, given the fact that these caregivers are in a chronically stressful situation — they could be providing care for several years on end if a patient is experiencing a pretty significant bout with cancer – so resilience is a pretty important construct in this population,” he added.

Lastly, caregiver burden in this instance was the stress perceived by the caregivers to the home care situation of their loved ones with cancer.

Survey Results

The researchers aimed to evaluate the association between caregiver burden and psychological resilience and their effects on self-rated health among caregivers of patients with cancer.

To determine these associations, the researchers developed a psychosocial survey and recruited a national sample of 467 participants through Qualtrics Panels, an online data recruitment service.

Additional predictors included age, gender, marital status, employment status, years caregiving and emotional social support.

Overall, the majority of caregivers in the survey were female (61 percent), white (88 percent), married (77 percent) and employed (72 percent). The majority of patient diagnoses reported by their caregivers were either breast (21 percent), lung (15 percent) or gastrointestinal (15 percent) cancers.

Of surprise to Golub and Avram, the caregiver burden and psychological resilience interaction variable was not a significant predictor of self-rated health.

“I did, personally, expect to see more of an interaction between resilience and caregiver burden in predicting self-rated health,” Golub said. “It just seemed like logically it would make sense that psychological resilience would mitigate some of the burden that someone would feel, and therefore, maybe lessen that interaction with self-rated health.”

The researchers did find that caregiver burden, age, having a committed relationship and employment were significant predictors of self-rated health.

“The analysis we did on the other predictors seemed like it made a lot of sense … That just led us to think of an intervention in the future that takes the entire person into account rather than just thinking about anxiety and depression, and just psychological factors — taking more social factors into account can really help with the stress that caregivers perceive,” said Golub.

“This gives us initial insight in to what you would call existential variables — meaning in life, hope for the future – so it is possible in future analyses that there is a connection between burden and other existential factors that we just haven’t researched yet,” Avram added.

As a result, those predictors can serve as a guide for caregivers to strive toward achieving psychological resilience and to help address burden. For example, caregivers can focus on forming strong, close, personal relationships with other people; having some kind of security in their life; an outside resource to fall back on when times are tough; employment; and having a committed relationship, according to Golub.

“We know that things like scheduling, finances, emotional burden of caring for a patient with cancer, those can all have a toll on how you perceive your own health,” added Avram. “So, (caregivers should continue) working to maintain those relationships and positive things in your life, and continue to bolster yourself as a person who is going through this adverse experience.”