Cancer Patient Symptoms and the Independent Effects on Caregiver Sleep and Mood: A Modeling Approach.

Objective: Given the effects of patient symptom burden and the unclear temporal associations with family caregiver sleep difficulty and psychological mood states, we longitudinally examined the day-to-day concurrent impacts of caregiver-perceived patient symptom burden, caregiver self-reported sleep difficulty, and anxious and depressive feelings (mood) in home hospice family caregivers of patients with cancer.

Methods: In a secondary data analysis, we utilized dynamic structural equation modeling to observe the interdependent evolution of caregiver self-perception of sleep difficulty and mood, and caregiver perception of patient symptoms in 141 family caregivers from 12 home hospice programs.

Results: During hospice care, caregiver perception of patient symptom burden impacted caregivers' self-reported feelings of anxiousness and depressed mood (b = 0.005, SE = 0.002, CI [0.001, 0.009], p < 0.012) and these perceived worsening mood states increased caregivers' perception of worsening patient symptom severity (b = 0.34, SE = 0.186, CI [-0.054, 0.710], p < 0.037). However, caregiver-reported patient symptom burden exhibited no direct effect on caregiver perception of their own sleep difficulty. Thus, caregiver self-reported sleep difficulty was indirectly impacted by caregiver self-reported mood; as mood worsened, caregiver-perceived sleep difficulty worsened (b = 0.10, SD = 0.024, CI [0.054, 0.148], p < 0.001).

Conclusions: As patient death approaches during home hospice, our findings suggest that caregivers' perceptions of patient symptoms and caregiver self-report of mood and sleep difficulty worsen over time and are interrelated. These findings suggest that caregiver mood may influence the experience of sleep difficulty; therefore, interventions that address mood may benefit sleep-focused strategies.