Abstract:
Over the past decade, changes in health, economic, and social policies have
shifted the dying process out of hospitals and into the community. This exploratory,
hypothesis-generating study investigated positive and negative caregiving as well as
care management resources of community-based end-of-life caregivers and how they
related to caregivers' personal growth following the death of the care receiver.
Retrospective, cross-sectional survey data were collected from 144 respondents
in Lane County, Oregon who reported having provided care for at least one terminally
ill person. Data were analyzed using an adapted stress process conceptual framework.
Factor analyses determined whether internally consistent measures could be obtained
from two new indices related to end-of-life care: a caregiving inventory and a care
management resource index. Hierarchical multiple regression analysis examined the
mediational relationships between care management resources and positive and
negative caregiving in predicting personal growth of end-of-life caregivers following
bereavement.
Factor analyses verified that the investigator-developed caregiving inventory
was comprised of two conceptually distinct factors, negative caregiving and positive
caregiving, and the care management resource index was comprised of a single factor,
care management resources. Factor scores were generated as a last step in factor
analyses. Hierarchical multiple regression analysis was then undertaken with personal
growth as the dependent variable. Control variables (age, gender, ethnicity, education,
income, and level of caregiving) were entered first, the care management factor score
was entered next, and the positive and negative caregiving factor scores were entered
last.
As predicted, higher levels of care management resources were associated with
more positive caregiving and higher levels of positive caregiving were associated with
greater personal growth. There was no relationship between negative caregiving and
personal growth, nor was negative caregiving related to care management resources.
The regression analysis did not support a mediational model.
Results from this study add to the evidence that positive and negative aspects
of caregiving should be treated separately and demonstrate the influence of positive
perceptions of end-of-life caregiving experiences on long-term bereavement outcomes.
Findings suggest the value of interventions designed to promote and enhance positive
aspects of the end-of-life caregiving experience.
