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

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.

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.

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).

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.