Iran Journal of Nursing

Mendeley  

Zotero  

Rajabi M, Bastami M, Shahvaroughi Farahani N, Tavanaie A H, Ghanbari B, Alasti H. Religious Coping as a Predictor of the Burden of Care in the Caregivers of End-stage Cancer Patients. IJN 2018; 31 (114) :6-16
URL: http://ijn.iums.ac.ir/article-1-2751-en.html

Background & Aims: Advanced cancer is accompanied by physical, mental, and social complications in the patients. During the diagnosis and treatment processes, the necessary care is provided to the patient by formal caregivers for only a short period at the hospital; in other cases, the care is provided by informal caregivers. Informal caregivers are untrained individuals who are not paid for care provision, delivering care to their family members and close relatives. Under such circumstances, if the caregiver is not able to manage the caretaking time and their personal time, they will become prone to caregiver burden. Caregiver burden has a covert and personal nature, encompassing components such as time-related, evolutionary, physical, social, and emotional caregiver burden. The concept has external and internal dimensions; the external dimension of caregiver burden consists of the factors that are related to the patient, such as attention to the patients’ needs, allocating time to the patients, and the provided services for the recovery of the patients. Internal caregiver burden involves personal beliefs, angers, internal emotions, and the individual’s sense of importance toward the role of the caregiver. Meanwhile, coping strategies are the internal factors used by caregivers in the face of life tensions. In this regard, the role of religion as a strategy for coping with stress is considered as a form of defensive mechanism in a positive view (benevolent religious reappraisal, reappraisal of God's power, seeking spiritual support, collaborative religious coping, religious purification, religious redemption, religious helping, religious focus, spiritual connection, and seeking support from clergies) and a negative view (reappraisal of the punishing God, active/passive deference, self-directing religious coping, demonic reappraisal, spiritual discontent, and interpersonal religious discontent). Despite the importance of coping strategies and role of religion as an index that has been constantly emphasized in facing difficulties and adversities, it remains unclear in the literature whether religious coping could predict the caregiver burden of the caregivers of advanced cancer patients. Although extensive research has been conducted in this regard, further investigations should be focused on end-stage cancer patients and their caregivers. The present study aimed to predict the burden toleration among end-stage cancer patient caregivers based on their religious coping styles.
Materials & Methods: This cross-sectional, correlational study was conducted on the caregivers of end-stage cancer patients referring to the palliative care center of Firoozgar Hospital in Tehran, Iran during April-September 2017. In total, 154 individuals were selected via convenience sampling based on Tabachnick and Fidell sample size estimation method. The inclusion criteria were the minimum caregiving period of one month, disease course and treatment (end-stage patients requiring a main caregiver for full-time care), basic literacy (ability to read and write), age of 15-75 years, Iranian nationality, and willingness to participate in the research. The exclusion criterion was the diagnosis of psychotic disorders in the patients affecting the interview process and validity of responses. Data were collected using the caregiver burden inventory by Guest and Novak and the religious coping questionnaire (RCOPE) by Pargament with 14 items. Data analysis was performed in SPSS version 16 using Pearson’s correlation-coefficient and multiple regression analysis simultaneously.
Results: Out of 146 participants, 71 (48.6%) were male and 75 (51.4%) were female within the age range of 15-72 years. No significant association was observed between the positive religious coping style and caregiver burden, while the negative religious coping style was positively and significantly correlated with the caregiver burden, with the correlation level of 34%. Furthermore, the negative religious coping style (t=4.444; β=0.352) could significantly predict the caregiver burden, while the positive religious coping (t=0.438; β=0.035) could not significantly explain the caregiver burden.
Conclusion: According to the results, the positive religious coping style and caregiver burden had no significant correlation, while the association between negative religious coping style and caregiver burden was positive and significant. Therefore, using the negative religious coping styles could reduce mental health and increase the caregiver burden. In fact, as a dimension of spirituality and a coping style, religion could result in the reduction of tensions, and the World Health Organization (WHO) has also acknowledged spirituality as a fundamental factor to enhance mental health. On the other hand, the positive religious coping style could not predict the caregiver burden in this study. Long-term and extensive care provided to end-stage cancer patients by the caregivers may reduce the effectiveness of coping strategies (e.g., positive coping styles) in the reduction of the caregiver burden due to the prolonged disease course and treatment process. Our findings also indicated that the negative religious coping style exerted a negative impact on the burden tolerance of the caregivers of the end-stage cancer patients, exposing these individuals to a higher sense of burden and reduced quality of life. As such, training on coping skills with a focus on improving positive religious coping strategies in the caregivers of cancer patients since the initial stages of the disease could be an effective step toward reducing the caregiver burden incurred upon these caregivers during the treatment process. In conclusion, it is recommended that the results of this study be incorporated into the psychological services provided to the caregivers of end-stage cancer patients in order to decrease their burden.