Caregiver burden, patients' self-perceived burden, and preference for palliative care among cancer patients and caregivers.
OBJECTIVE
Recently, caregiver burden (CB) has emerged as an important issue in the area of palliative medicine. However, patients' feelings related to being a burden to their families (i.e., self-perceived burden [SPB]) is also a significant issue. We evaluated the relation of CB and SPB as preference for palliative care.


METHODS
A national, multicenter, cross-sectional survey of 326 patient-caregiver dyads was performed. A set of paired questionnaires evaluating CB and SPB (five domain items assessed on a four-point Likert scale) were independently administered to patients and their caregivers. Among the respondents, only the patients with distant stage cancer and their caregivers were included. Multivariate analyses were conducted to identify the associations between CB and SPB and preference for palliative care.


RESULTS
Caregivers and patients who preferred palliative care to life sustaining treatment reported higher CB and SPB scores, respectively. Caregivers who felt more of a burden were more likely to prefer palliative care over life sustaining treatment for their patients (adjusted odds ratio [aOR] = 1.67, 95% CI: 1.21-2.31). In addition, patients who perceived their caregivers' burden as large tended to prefer palliative care (aOR = 1.61, 95% CI: 1.16-2.22).


CONCLUSIONS
Both CB and SPB increased preference for palliative care. This could be interpreted that high CB can lead to preference for palliative care in both patients and their caregivers, potentially threatening patient autonomy. Efforts to relieve CB and SPB are needed.
Department of Family Medicine/Cancer Survivorship Clinic, Seoul National University Hospital, Seoul, Korea.|Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
Ji Eun
JE
Lee
Department of Family Medicine/Cancer Survivorship Clinic, Seoul National University Hospital, Seoul, Korea.|Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
Dong Wook
DW
Shin
Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.|Departments of Health, Behavior and Society, and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.
Juhee
J
Cho
Division of Cancer Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Korea.
Hyung Kook
HK
Yang
Division of Cancer Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Korea.|College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju-si, Korea.
So Young
SY
Kim
Department of Family Medicine/Cancer Survivorship Clinic, Seoul National University Hospital, Seoul, Korea.|Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
Hyo Sang
HS
Yoo
Hospice and Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang-si, Korea.
Hyun Jung
HJ
Jho
Department of Counseling Psychology, Hanyang Cyber University, Seoul, Korea.
Joo Yeon
JY
Shin
Department of Family Medicine/Cancer Survivorship Clinic, Seoul National University Hospital, Seoul, Korea.|Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
Belong
B
Cho
Division of Cancer Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Korea.
Keeho
K
Park
Division of Cancer Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Korea.|College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju-si, Korea.
Jong-Hyock
JH
Park
D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D010166:Palliative Care / Q000523:psychology*; D057240:Patient Preference / Q000706:statistics & numerical data*; D056910:Republic of Korea; D012649:Self Concept; D011795:Surveys and Questionnaires