Factors contributing to Role Strain among Family Caregivers of Adult Patients Suffering from Cancer at Kenyatta National Hospital

Abstract

Cancer is a global health burden which is affecting every region in terms of socio-economic, psychological and physical strain placed on patients and their families. Many family caregivers are thrust into cancer caregiving without any training or healthcare system support, yet the services they render could affect the patient treatment outcomes. Therefore, the purpose of this study was to assess the level of role strain and its contributing factors among family caregivers of adult patients suffering from cancer at Kenyatta National Hospital outpatient cancer treatment clinic. This study adopted analytical cross-sectional design involving 255 systematically sampled family caregivers and their corresponding adult cancer patients attending Kenyatta National Hospital outpatient cancer treatment clinic between February and March 2020. Specialized nurses in cancer care and medical social workers were also recruited as key informants through census. Both quantitative and qualitative data was collected. Quantitative data from structured questionnaire, Modified Caregiver Strain Index (MCSI) tool and ECOG-PS scale for performance status was analyzed by deriving descriptive statistics and ordinal logistic regression was performed to derive the relationship between the independent variables and the dependent variable. Quantitative data was presented by use of tables and chart. SPSS software version 25 was utilized in data analysis. Qualitative data from 3 focus group discussions involving purposefully selected family caregivers and 6 key informants were transcribed verbatim and analyzed thematically. The study findings revealed that 44.3% of family caregivers had moderate role strain. The study further revealed that family caregiver related factors influencing family caregiver role strain included being married (OR=0.49, p=0.038), being unemployed (OR=3.29, p=0.001), <5 hours of caregiving per day (OR 0.40, p=0.002), social isolation (OR=0.20, p=0.001) and transportation costs (OR=0.32, p=0.017), In addition, qualitatively; the following themes emerged; lack of social support, costly transportation and accommodation services. The patient related factors influencing family caregiver role strain included patient’s county of residence (OR=0.54, p=0.028), good functional status (OR=0.33, p=0.001), patient’s current treatment modality (OR=0.21, p=0.001) and current interpersonal relations with the patient (OR=0.30, p=0.001). The institutional related factors influencing family caregiver role strain included physical strain during navigation (OR=0.39, p=0.033), shortage of cancer drugs (OR=0.30, p=0.005) and traversing long geographical distance (OR=0.38, p=0.008). In addition, qualitatively; the following themes emerged; physical strain, costly cancer treatment services, geographical disparity and treatment process challenges. In conclusion, role strain among family caregivers of adult patients with cancer is prevalent and there are various factors (family caregiver, patient and institutional) which influence the role strain. Therefore, this study recommends that healthcare practitioners should screen family caregivers for role strain and pro-actively consider them for psychological counselling, social support groups, caregiving skills training, health education and provision of literature materials on self-care, self financial empowerment and referal for respite care if available.