Abstract
OBJECTIVES: In a longitudinal design, this study investigates the role of the quality of relationships in the well-being of caregivers for a family member with advanced cancer, specifically, the quality of relations among family members and the caregiver's commitment to caregiving. Following the stress process model, good quality of relations and caregiver's high commitment should be resources mitigating caregiver burden, even though overinvestment in the caregiver role may lead to the opposite outcome. METHODS: Data were drawn from a longitudinal study of 336 caregivers of advanced cancer patients in an urban community, who were interviewed shortly after patient diagnosis and again 3 months later. Caregiver burden is measured by 4 subscales (17 items) of the Caregiver Reaction Assessment. We used a random-effect model to investigate the association between caregiver burden and the 2 focused contributing factors-caregiver commitment and family relationship quality-when other covariates were controlled. A fixed-effect model then examines the association between the changes in caregiver burden and related time-varying factors, including caregiver commitment, when family relationship quality was used as a moderator. RESULTS: Both the random and fixed-effect models consistently show that a cancer caregiver's positive commitment to the patient reduces caregiver burden, and family relationship quality provides an overall moderating influence that reduces the felt burden. DISCUSSION: The quality of relations between the caregiver and patient and with others in the family network is critical in understanding caregiver burden in advanced cancer and should be viewed as part of long-term family dynamics.