3.1. Baseline characteristics of family caregivers
A total of 536 caregivers were investigated, There were 306 males (57.09%) and 230 females (42.91%); the age range was 24 ~ 69, with an average age of 50.30 ± 7.99 years; the time range of caring for patients was 1 ~ 5 years, with an average length of care of 3.01 ± 0.962 years; the relationship with patients was mainly 418 spouses (77.99%), 28 children (5.22%), 14 parents (2.61%), 32 brothers and sisters (5.97%) and 44 other relatives (8.21%) ,Table 1 for the basic information of the research objects
Table 1 basic information of research objects
Variables
|
Number
|
Rate
|
Gender
|
|
|
male
|
306
|
57.09%
|
female
|
230
|
42.91%
|
Occupation
|
|
|
civil servant
|
82
|
15.30%
|
technician
|
228
|
42.54%
|
businessman
|
134
|
25.00%
|
farmer
|
28
|
5.22%
|
unemployed
|
64
|
11.94%
|
Marital status
|
|
|
In marriage
|
501
|
93.47%
|
single
|
5
|
0.93%
|
divorce
|
22
|
4.10%
|
Widowed
|
8
|
1.49%
|
Educational background
|
|
|
Primary School Education
|
35
|
6.53%
|
Junior high school education
|
271
|
50.56%
|
High school / technical secondary school
|
125
|
23.32%
|
University/college education
|
85
|
15.86%
|
Graduate education or above
|
20
|
3.73%
|
Relationship with patients
|
|
|
children
|
28
|
5.22%
|
parent
|
14
|
2.61%
|
spouse
|
418
|
77.99%
|
brothers and sisters
|
44
|
8.21%
|
Other relatives
|
32
|
5.97%
|
Monthly Income
|
|
|
<5000
|
368
|
68.66%
|
5001-8000
|
125
|
23.32%
|
8001-10000
|
38
|
7.09%
|
>10000
|
5
|
0.93%
|
3.2 Current situation of fatigue, rumination thinkingn, sleep quality and hopelessness of family caregivers
3.2.1 Fatigue status of patients with malignant tumors
The total fatigue score of 536 respondents was 10.20 ± 2.50, the score range was 3-14, the average score of physical fatigue dimension was 6.09 ± 0.97, and 455 (84.89%) participants were "do you feel physical strength is not enough?" "Yes" is selected on this issue; The average score of mental fatigue dimension was 4.11 ± 1.56; In the dimension of mental fatigue, 532 people, 99.25% chose "yes" on the question "do you have difficulty concentrating"; 504 caregivers (94.03%) had a total fatigue score of more than 7.
3.2.2 Rumination thinking
The total score of rumination thinking was 43.42 ± 5.89, and the score range was 26-61 points. The total score of depression factor was 24.98 ± 3.66, and the score of numbness to other things was the highest, 3.19 ± 0.54; The total score of forced meditation factor was 9.73 ± 1.59, and the highest score was 2.88 ± 0.45; The total score of reflection factor is 8.94 ± 1.51, among which the score of "I often think alone about why it is like this" is the highest, 1.97 ± 0.27. 73.69% of the caregivers (395 / 536) had a higher total score of rumination thinking than the average.
3.2.3 Sleep quality
The total sleep score was 8.35 ± 1.59, with a score range of 4-15. 6.7% (36 / 536) of the caregivers had poor sleep quality; the average sleep time of 5.7% (31 / 536) of the caregivers was 19.66 ± 2.12min, and 11.00% of the caregivers had difficulty falling asleep < 1 week/time. The total sleep quality score and each factor score are shown in Table 2.
3.2.4 Hopelessness
The results of the baker's despair scale showed that 41.42% (222 / 536) of family caregivers had a total despair score above 10. The total despair score and average scores of each dimension are shown in Table 2.
Table 2 fatigue, rumination, sleep status and hopelessness of caregivers of cancer patients
variable
|
(±s)
|
Score range
|
variable
|
(±s)
|
Score range
|
FS-14
|
|
|
PSQI
|
|
|
physical fatigue
|
6.09±0.97
|
3-8
|
sleep quality
|
1.07±0.25
|
0-2
|
mental fatigue
|
4.11±1.56
|
0-6
|
sleep latency
|
1.06±0.23
|
1-2
|
Total score
|
10.20±2.50
|
3-14
|
sleep time
|
1.07±0.28
|
0-3
|
RRS
|
|
|
sleep efficiency
|
1.08±0.31
|
0-3
|
Depression
|
24.98±3.66
|
15-33
|
sleep disturbance
|
1.05±0.24
|
0-3
|
Forced meditation
|
9.73±1.59
|
6-13
|
Sleeping drugs
|
1.98±0.47
|
1-3
|
Reflection factor
|
8.94±1.51
|
5-12
|
daytime sleep disorders
|
1.05±0.23
|
0-3
|
Total score
|
43.42±5.89
|
26-61
|
Total score
|
8.35±1.59
|
4-15
|
BHS
|
|
|
|
|
|
Feelings about the future
|
4.00±1.61
|
0-7
|
|
|
|
Loss of motivation
|
5.18±2.69
|
0-8
|
|
|
|
Expectations for the future
|
1.29±1.42
|
0-5
|
|
|
|
Total score
|
10.47±5.32
|
1-20
|
|
|
|
3.3 correlation analysis of caregivers' fatigue, rumination thinking, sleep quality and hopelessness in patients with malignant tumors
Pearson correlation analysis showed that there was a positive correlation between the total scores of RRS, fs-14, PSQI and BHS (r = 0.483 ~ 0.906, P < 0.01). The correlation analysis between fatigue, rumination thinking, sleep status and hopelessness of family caregivers of cancer patients is shown in Table 3.
Table 3 Correlation Analysis of fatigue, rumination, sleep status and hopelessness of caregivers of cancer patients
|
RRS
|
FS-14
|
PSQI
|
BHS
|
RRS
|
1
|
|
|
|
FS-14
|
0.906**
|
1
|
|
|
PSQI
|
0.619**
|
0.503**
|
1
|
|
BHS
|
0.903**
|
0.841**
|
0.483**
|
1
|
“*”:P<0.05;“**”:P<0.01
2.4 path analysis of caregivers' fatigue, rumination thinking, sleep quality and hopelessness in patients with malignant tumors
By consulting relevant literature and data, it is found that there are the following action pathways among caregivers' fatigue, rumination thinkingn, sleep quality and hopelessness of patients with malignant tumors: ① fatigue → rumination thinkingn; ② sleep → rumination thinkingn; ③ Fatigue → rumination thinkingn → hopelessness ④ sleep → rumination thinkingn → hopelessness ⑤ hopelessness → sleep. The structural equation model of caregivers' fatigue, rumination thinkingn, sleep quality and hopelessness in patients with malignant tumors is shown in Figure 1; The results of each direct path effect are shown in Table 4; The goodness of fit of the model is shown in Table 5.
Table 4 Direct path coefficients and significance test of fatigue, sleep quality, rumination and hopelessness of caregivers of patients with malignant tumor
Path
|
Estimated value
|
SE
|
Critical value
|
P
|
fatigue→sleep quality
|
0.941
|
0.197
|
4.783
|
0.000
|
fatigue→rumination thinking
|
0.865
|
0.049
|
17.492
|
0.000
|
sleep quality→rumination thinking
|
0.738
|
0.076
|
9.683
|
0.000
|
rumination thinking→hopelessness
|
0.870
|
0.020
|
44.070
|
0.000
|
hopelessness→sleep quality
|
-0.567
|
0.188
|
-3.023
|
0.018
|
Table 5 Model fitting index of fatigue, sleep quality, rumination and hopelessness of caregivers of patients with malignant tumor
Indexes
|
χ2/df
|
P
|
GFI
|
IFI
|
TLI
|
CFI
|
RMESEA
|
Fitting index
|
0.137
|
0.712
|
1.000
|
1.001
|
1.003
|
1.000
|
0.000
|
Evaluation criterion
|
≤3
|
>0.05
|
>0.90
|
>0.90
|
>0.90
|
>0.90
|
<0.10
|