الفهرس 
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Abstract
Cancer is a life threatening illness that may have some similarities to chronic illness in their longevity, but the prognoses are often terminal. The impact of care giving process is great; the family caregivers` psychological health can deteriorate and low level of self-efficacy is presented, due to that care giving role restricts their social, personal, and vocational desires, also they are not quite trained in care giving and this leads to additional burden. Caregivers of patients with cancer trying to modify their lifestyles to accommodate the child’s needs, this disturbance in the family functioning have been associated with higher levels of depression. If the caregivers have a sense of self efficacy this may protecting against the adverse effect of caregiver burden on their depressive symptoms.
The present study aims to determine the degree of burden, depression and self-efficacy among care giving parents of children with cancer.
The study followed a descriptive correlational research design. It was carried out at the outpatient clinic of Sporting Students Hospital. The subjects of the present study consisted of 200 care giving parents of children with cancer who were recruited from the outpatient clinic of Sporting Students Hospital and met the following inclusion criteria: Either child`s mother or father who is directly involved in the child care, the child already started the treatment for at least two weeks, free from other medical diagnose and accepting to participate in the study.
The data for this study were obtained using the following tools:
Tool (1): Care giver and children socio-demographic and clinical data structured interview schedule
The tool included two parts, part one for the caregiver to elicit data such as caregiver`s age, sex, level of education, and occupation. Part two eliciting data about the child with cancer such as age, sex, birth order, type of cancer, type and duration of treatment.
Tool (2): Caregiver Burden Inventory (CBI):
This tool was designed by Novak & Guest (1989) as a multi-dimensional self-reported questionnaire measuring caregiver burden. It consists of 24-item are rated on a 5 point Likert scale which ranges from 0 (never) to 4 (nearly always). The scale measures 5 dimensions of caregiver burden namely: time dependence burden (5 items), developmental burden (5 items), physical burden (4 items), social burden (5 items) and emotional burden (5 items).
Tool (3): Caregiver Self-Efficacy Scale (CaSES):
This tool was designed by Ugalde et al. (2012), to assess self-efficacy in caregivers of people with cancer. The scale includes 21 items reflecting four subscales namely: Resilience (6 items), Self-Maintenance (6 items), Emotional Connectivity (5 items) and Instrumental Care giving (4 items). The responses are rated on a 4-pointlikert scale ranging from 0 (not at all confident) to3 (very confident).
Tool (4): Center for Epidemiologic Studies Depression (CES-D) Scale:
The Center for Epidemiologic Studies Depression Scale (CES-D) was developed by Radloff (1977) for general population. The scale is self-reported measurement to assess symptoms associated with depression experienced in the past week. The scale includes 20 items reflecting some areas of depression, i.e. depressed mood, somatic complaints, positive affect and interpersonal problems. The responses are rated on a 4-point likert scale ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Four items (4, 8, 12, and 16) are reversely scored.
The following are the main results yielded by the present study:
I: Socio- demographic and clinical data of studied care giver parents and their sick child.
a- The caregiver parent`s data.
- About three quarters of the subjects (72.5 %) were mothers.
- The subjects mean age was 36.42± 6.20 years; about half of the subjects (48.5%) were in the age group ranging from 35 to less than 45 years.
- About one third of the studied subjects (34.0%) had an academic education. Whereas, 19% of the studied subjects were illiterate.
- More than half of the studied caregivers (53.0%) were house wife, more than one third of the studied subjects (36.5%) were employee, and 10.5% were having free job.
- Most of the subjects (79.8 %) had absenteeism from their work, 10.6 % make vacation without salary due to their caregiver role.
- The majority of the studied subjects (88.5%) have enough income
- More than half of the studied care givers (59.5%) reported that side effects after the dose of chemotherapy were the most bothering issue to them during care giving process.
52.5% of the studied care givers reported that crying and want to be alone was their coping way with bothering issues, while 29.0 % reported that they using aggressive behaviors as(shouting , hitting, quarrelling), whereas 27.5 % reported reading Quran, praying , and only 2.5% reported that cigarettes smoking.
b- The sick child`s data.
- As regard to the age, the subjects` sick children mean age was 7.93 ± 4.61 years, in which more than one third of the sick children (39.5%) were in the age group ranging from 1 to less than 6 years.
- More than half of the sick children (54.4%) were in primary school, 73.8% of those children were independent in accomplishing their home work.
- 56.0% of children were having leukemia.
- 91.0% of the sick children treated with Chemotherapy.
- 80.5% of the children were treated for a period of time less than one year.
More than half of the sick children (55%) were admitted to the hospital more than four times per month.
- 38.0% of the caregivers reported that their child hospitalized for about 3-4 days in each admission.
II: Caregiver burden of the studied parents.
- The mean score percent of total burden among the studied caregiver parents was 63.59±13.94% reflecting high degree of burden, in which the majority of them (96.0%) were at high risk for burn out.
- The mean score percent of the Developmental burden among the studied parents was 78.03±18.99%, the majority of the studied caregivers (93.5%) were at high risk for burn out, while (6.5%) were in need to seek some form of respite care.
- The mean score percent of the Time dependency burden among the studied parents was 74.40±17.56 %, and all the studied caregivers (100.0%) were at high risk for burn out due to high level in time dependency burden .
- The mean score percent of the Social burden was 62.85±17.35%, the majority of the studied caregivers (91.0%) were at high risk for burn out among the social burden, while (9.0%) of the studied caregivers were in need to seek some form of respite care.
- The mean score percent of the Physical burden was 57.56±16.06%, the majority of the studied caregivers (92.0%) were at high risk for burn out, and 8.0% of the studied caregivers were in need to seek some form of respite care.
- The mean score percent of the Emotional burden among the studied parents was 43.93±20.99%, about two third of the studied caregivers (65.0%) were at high risk for burn out, while (23.5%) of the studied caregivers haven’t emotional burden.
III: Self- efficacy of the studied parents.
- The mean score percent of the self efficacy among the studied caregiver parents was 52.34± 12.02 %,showing that the majority of the studied caregiver (81.0%)had moderate level of self efficacy.
- Concerning the four domains of self efficacy among the studied caregiver parents it was observed that Instrumental care giving, Resilience, and Emotional connectivity domains had the highest mean score percent (71.12± 15.83 %, 56.64±16.06%, and 46.67±16.01 %, respectively).While Self- maintenance domain had the lowest mean score percent (38.58±18.19%).
- More than two thirds of the studied caregivers (68.0%) had high level of Instrumental care giving, while more than half of the subjects (59.5%)had moderate level of Resilience, 51.5% of them had moderate level of Self- maintenance, and about two thirds of the studied caregivers (66.0%) had moderate level of Emotional connectivity.
IV: Depression of the studied parents.
- 99.0% of the studied care giver parents had depression with the mean score percent of 61.84±15.87 reflecting a very high level of depression.
V: The correlation between the self-efficacy, burden and depression among studied caregiver parents revealed that:
- There is a negative significant correlation between self- efficacy and between caregiver burden and depression in which (r= -0.366, p<0.001 and r= -0.315, p< 0.001) respectively.
- There is a negative significant correlation between caregiver burden and depression (r =0.759, p<0.001).
Accordingly the following are the main recommendations of the present study:
1- Continuing assessment of the parents‟ supportive care needs throughout the cancer journey as individuals experience varying degrees of needs that differ from one another and that may change over time.
2- The Family caregiver have to be included in the plan of child care, so they should be provided with education to strengthen their ability to manage living with the cancer patient and reducing the degree of burden.
3- Provide Family caregiver with psycho-educational program about how to manage stressful situations, and increasing level of self efficacy.
4- Family caregiver needs another potential powerful intervention for support such as Internet support. It help in meeting the FCs needs for support and information, and to assist FCs to manage their own health problems and cope with the burdens of caring for a cancer patient by providing tailored information, as well as a chance for peer and professional communication and support.
5- Psychiatric health care nurse have an opportunity to emphasize issue of support FCs by collaborating with their colleagues in pediatric oncology, to improve their management of symptoms, including those less visible such as emotional and communication issues.
6- More studies are needed to better understand the variations in care giving experiences over time and how the care giving perspective is influenced by different cultural.
7- Further research is required to determine which variables are determinants of psychological adjustment of FCs, followed by studies to evaluate the most effective ways of implementing the appropriate interventions.