Education
Education Intervention ‘‘Caregivers Like Me’’ for Latino Family Caregivers Improved Attitudes Toward Professional Assistance at End-of-life Care
American Journal of Hospice & Palliative Medicine® 1-10 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049909115584315 ajhpm.sagepub.com
Dulce M. Cruz-Oliver, MD, CMD1, Theodore K. Malmstrom, PhD2, Natalia Ferna´ndez, BS3, Manas Parikh, BS4, Jessica Garcı´a, MD5,6, and Sandra Sanchez-Reilly, MD, FAAHPM6,7
Abstract Objective: This study explores the ability of a culturally sensitive and case-based education intervention, Caregivers Like Me, to improve knowledge and attitudes regarding end-of-life (EOL) resources among Latino caregivers. Methods: A multicentered, cross-sectional study of Latino communities from different geographical regions and cultural backgrounds. An educational intervention was administered to family caregivers of Latino elders using a case-based video ‘‘telenovela’’ and pretest–posttest questionnaires. Results: Participants (N ¼ 145) were mostly females (79%) with mean age of 56 + 15 years. They reported active learning from intervention (91%) and high satisfaction (92%) with educational experience. Both caregiver stress selfawareness and willingness to accept professional help improved significantly from pretest to posttest. Conclusion: A culturally sensitive educational intervention increased Latino caregivers’ self-awareness about caregiver stress and the need to consider professional assistance for EOL care. Keywords family caregivers, Latino, culture, end of life, hospice, palliative, education intervention, pretest–posttest
Introduction There is an effort in achieving high-quality, cost-effective, patient-centered, culturally sensitive care for terminally ill patients. Yet, for frail elders with advanced illness and multiple chronic diseases, patient-centered care is impossible without caregiver involvement. Non-professional family caregivers often provide significant contributions to end-of-life (EOL) care. At any time, an estimated 42 million Americans serve as caregivers to adult patients, and on average they spend 20 h/wk on caregiving.1 Caregivers respond to patients’ health needs in many ways such as assistance with activities of daily living, advocacy for patient needs, support their decisionmaking process or making the decisions for them, and emotional and spiritual support.2 The US Latino population includes approximately 6% adults aged 65 and older3 and has experienced a significant growth in all 50 states from 2000 to 2010.4 By 2050, it is projected that 15% or more of Social Security beneficiaries aged 62 or older will be Hispanic.3 Cross-cultural research with Latinos has shown that personal connections aid in the development of rapport and trust building, which are crucial for the dialogue surrounding palliative care, hospice, and EOL discussions.5 It is therefore essential to consider culturally specific
factors associated with EOL care for Latino patients and caregivers.6 End-of-life care delivery to Latinos is a well-documented challenge.7,8 The majority of caregivers for Latino patients are family relatives (ie, ‘‘la familia’’). Latino caregivers may spend 1
Division of Geriatrics Medicine, Saint Louis University, South Grand Blvd, St Louis, MO, USA 2 Department of Neurology & Psychiatry, Saint Louis University School of Medicine, St Louis, MO, USA 3 University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA 4 Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO, USA 5 Division of Geriatric Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA 6 GEC and GRECC, South Texas Veterans Health Care System, San Antonio, TX, USA 7 The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA Corresponding Author: Dulce M. Cruz-Oliver, MD, Division of Geriatrics, Department of Internal Medicine, Saint Louis University, 1402 South Grand Blvd M238, St Louis, MO 63104, USA. Email: [email protected]
Downloaded from ajh.sagepub.com at Bobst Library, New York University on November 14, 2015
American Journal of Hospice & Palliative Medicine®
2 more hours in the caregiving role than other ethnic groups9 and are less likely to use available health care services other than their own families10,11 because they think family members should provide the care.6 While common family values may change over time due to numerous factors, namely, acculturation, studies have shown that acculturation level does not influence Latino family caregivers’ decision-making preferences12 or service access.13 Many Latinos report preferences for limited patient autonomy and family-centered decision making, even when patients are able to make decisions by themselves.14 The combination of all these factors may result in Latinos not accessing EOL available resources because health care systems are not tailored toward their way of making decisions. This lack of health care access can expose caregivers to an increased burden and therefore make Latino elders more vulnerable to receive aggressive care. Education along with interventions centered on culturally related values may be needed to increase hospice use among Latinos.15 One study has shown that approaching Latino elders using a ‘‘novela or telenovela’’ may be a good method to communicate and educate them about health issues.15 A telenovela is usually a television show that narrates stories of few people intertwined into a dramatic plot; unlike soap operas, telenovelas are designed with an ending. Latinos are well known for liking telenovelas per Latino channels ratings.16 We developed an EOL bilingual education intervention for Latino caregivers, Caregivers Like Me, which uses a video soap opera (telenovela). Details of telenovela development will be published elsewhere, and in this article, we intend to report the testing of Caregivers Like Me ‘‘telenovela’’. The study aims to investigate whether educating Latinos using a telenovela can help decrease caregiver stress and improve their attitudes toward the utilization of EOL services.
Methods Study Design and Setting This is a multicenter, cross-sectional study of Latino caregivers from Puerto Rico (Arecibo, Jayuya, and San Juan: Hispanics of Puerto Rican descent), Texas (San Antonio: Hispanics of mostly Mexican descent), and Missouri (St Louis: Hispanics of mostly Central and South American descent). The Saint Louis University and University of Texas Health Science Center at San Antonio Institutional Review Boards approved this project.
Participant Recruitment Participants were volunteer caregivers of communitydwelling patients from Missouri, Texas, and Puerto Rico. Eligible study participants were nonprofessional caregivers aged 18 years and older who cared for a Latino elder. Community leaders at the study sites recruited participants using phone, e-mail, verbal announcements at church or lay congregations, and recruitment flyers. No compensation or incentive was
provided. Participants self-reported their ethnicity and Spanish proficiency.
Study Instruments Education tool, Telenovela. To explore Latino elders’ EOL care, we started with a literature review,5 which demonstrated that Latino elders face EOL decisions with family support and are receptive toward hospice if educated. Subsequently, we performed a needs assessment to study the gaps that exist in EOL care delivery,5 including the unknown need and acceptance of the hospice concept among Latinos. The needs assessment included focus groups with 45 hospice staff in Texas and Missouri and an experiential journal based on observations in hospice care in Puerto Rico. One solution suggested by participants was to provide education in Spanish done by religious leaders and to use media to promote EOL education and, specifically, to use a popular TV show format known as telenovelas or soap operas. Telenovelas are usually dramatic stories that aim to transmit sociocultural messages. Telenovelas are part of the Latino culture and are very popular to share among families and discuss crucial topics.17,18 The needs assessment results were used as a basis to develop an EOL education intervention for Latino caregivers. In particular, we decided to develop a bilingual (Spanish and English version) education intervention for Latino caregivers that included a video soap opera (‘‘telenovela’’), Caregivers Like Me. Details of telenovela development (ie, focus group results) will be published elsewhere, and in this article we intend to report the testing of Caregivers Like Me (telenovela). The education tool was a PowerPoint oral presentation that consisted of an introduction of session objectives, followed by the video presentation, and ending with a structured discussion. The structured discussion included definitions of hospice, palliative care, and caregiver stress and an explanation of services available for caregivers (ie, social services, support groups, adult day care, chore worker, home care with or without palliative care, and respite care under hospice). To minimize variation, all sessions were delivered by 1 of 2 researches (DC and JO) and a structured script was used to deliver the PowerPoint oral presentation. Figure 1 demonstrates the design of education tool. Education evaluation, pretest–posttest. A pretest–posttest design was done using Levels of Kirkpatrick19 to evaluate reaction and learning. In addition to the education intervention, participants were contacted by phone 4–7 months postintervention to evaluate their intention to change behavior. Pretest–posttest and phone survey questionnaire validation were done using a list of 12 questions that were created (by DC) and underwent field testing by 12 judges for content validity.20 These judges were a convenience sample of study researches (MP, TKM, SSR, JO, and NF) and potential participants from each study site (Puerto Rico, Texas, and Missouri) who did not participate in any of the sessions. The final pretest–posttest and phone survey questionnaire included 10 items.
Downloaded from ajh.sagepub.com at Bobst Library, New York University on November 14, 2015
Cruz-Oliver et al
3
Figure 1. Flowchart of education intervention development. After revising the literature and analyzing focus groups transcripts a video ‘‘telenovela’’ was created and then showed to family caregivers. The Kirkpatrick level of evaluation was used to create pretest–posttest questionnaire as well as the phone survey. Intervention was delivered in the following order: pretest, presentation, posttest, and discussion.
The instrument was designed to measure changes in attitude, knowledge, and satisfaction with experience. Participant attitudes were explored using 3 pretest–posttest questions to assess caregiver burden awareness, awareness of the need for help while being a caregiver for a loved one, and level of acceptance of help from 5 EOL services (social services, adult day care, chore worker, home care, and hospice). Response options for the attitude questions included 5 categories using a Likerttype rating scale (strongly disagree ¼ 1 to strongly agree ¼ 5). The same scale was used for 2 questions measuring the level of satisfaction with content (learning from video) and with the education format (overall experience). Participant knowledge was examined using 2 categories of questions: pretest items explored caregiver familiarity with 7 EOL terms (palliative care, caregiver burden, EOL care, hospice, home care, social work service, chore worker), and the posttest items explored their ability to correctly identify the same 7 EOL terms. Posttest knowledge questions regarding EOL were scored as correct for agree/strongly agree responses (eg, palliative care, caregiver burden, EOL care, home care, and chore worker) or for disagree/strongly disagree responses (ie, reverse scored for hospice and social work). A 4- to 7-month follow-up phone survey explored caregivers’ intention to use any of 4 EOL services (chore worker, palliative/hospice care, home care, or support groups). Demographic data included age (years), gender (male/female), education (years), marital status, religion, patient diagnosis, caregiver relationship with patient, caregiver health status, the Patient Health Questionnaire-2 (PHQ-2; range 0 to 6; interpretation higher than 3 is positive for depressive symptoms),21 and Short-Zarit Caregiver Burden Scale (range 0 to 16; interpretation more than 8 is suggestive for caregiver burden).22,23 We collected these data to obtain a profile of caregiver demographics and to explore whether caregiver characteristics are associated with pretest–posttest answers.
Educational Intervention Study sessions were done at community centers, mostly church congregations, and lasted approximately 1 hour. In total, 8 sessions were provided with a median of 17 participants in each group. A recruitment statement was bilingually read to participants at the start of the meeting. A hard copy (English or Spanish) was distributed to caregivers who agreed to participate. Participants completed the pretest and demographic questions (10 min) at the beginning of the meeting. The oral presentation was then delivered in person and included a 15-minute video (Spanish telenovela) and 15-minute structured discussion on topics related to EOL caregiver burden. Participants then completed a posttest questionnaire (10 min) to measures reaction, learning, and attitude changes after the intervention. Data were collected anonymously using hard copy questionnaires.
Data Analysis Demographic data were analyzed using descriptive statistics. Parametric (t tests, analysis of variance [ANOVA]) and nonparametric (chi-square) statistics were used to analyze evaluations of knowledge and attitudes. Sensitivity analyses were performed to examine association between caregivers’ characteristics (age, gender, education, health status, marital status, religion, diagnosis of patient, relationship with patient, PHQ2, and Short-Zarit Scale) and posttest responses in attitude questions. Data analyses were performed using IBM SPSS Statistics version 21.0 (Somers, New York).
Results Caregivers’ Characteristics Baseline characteristics for EOL caregivers are provided in Table 1. The sample included N ¼ 145 Latinos who were
Downloaded from ajh.sagepub.com at Bobst Library, New York University on November 14, 2015
American Journal of Hospice & Palliative Medicine®
4 Table 1. Sample Baseline Characteristics.
Siteb Variablea Female, % Age, mean+ SD Education, % Elementary school High school College More than college Religion, % Christian (non-Catholic) Catholic Other Marital status, % Married Single Divorced or separated Widowed Relationship to patient, % Parents Siblings Children Other Patient diagnosis, % Heart disease Dementia Diabetes Cancer Hypertension Stroke Arthritis Self-rated health Poor-fair, % PHQ-2, score 3 (positive for depression),% Short Zarit Scale, score 8 (positive for burden), %
Total N ¼ 145
PR N ¼ 92
MO N ¼ 15
TX N ¼ 38
P-valuec
79 56+15
79 52+14
67 45+13
84 71+8
.367
Education Intervention ‘‘Caregivers Like Me’’ for Latino Family Caregivers Improved Attitudes Toward Professional Assistance at End-of-life Care
American Journal of Hospice & Palliative Medicine® 1-10 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049909115584315 ajhpm.sagepub.com
Dulce M. Cruz-Oliver, MD, CMD1, Theodore K. Malmstrom, PhD2, Natalia Ferna´ndez, BS3, Manas Parikh, BS4, Jessica Garcı´a, MD5,6, and Sandra Sanchez-Reilly, MD, FAAHPM6,7
Abstract Objective: This study explores the ability of a culturally sensitive and case-based education intervention, Caregivers Like Me, to improve knowledge and attitudes regarding end-of-life (EOL) resources among Latino caregivers. Methods: A multicentered, cross-sectional study of Latino communities from different geographical regions and cultural backgrounds. An educational intervention was administered to family caregivers of Latino elders using a case-based video ‘‘telenovela’’ and pretest–posttest questionnaires. Results: Participants (N ¼ 145) were mostly females (79%) with mean age of 56 + 15 years. They reported active learning from intervention (91%) and high satisfaction (92%) with educational experience. Both caregiver stress selfawareness and willingness to accept professional help improved significantly from pretest to posttest. Conclusion: A culturally sensitive educational intervention increased Latino caregivers’ self-awareness about caregiver stress and the need to consider professional assistance for EOL care. Keywords family caregivers, Latino, culture, end of life, hospice, palliative, education intervention, pretest–posttest
Introduction There is an effort in achieving high-quality, cost-effective, patient-centered, culturally sensitive care for terminally ill patients. Yet, for frail elders with advanced illness and multiple chronic diseases, patient-centered care is impossible without caregiver involvement. Non-professional family caregivers often provide significant contributions to end-of-life (EOL) care. At any time, an estimated 42 million Americans serve as caregivers to adult patients, and on average they spend 20 h/wk on caregiving.1 Caregivers respond to patients’ health needs in many ways such as assistance with activities of daily living, advocacy for patient needs, support their decisionmaking process or making the decisions for them, and emotional and spiritual support.2 The US Latino population includes approximately 6% adults aged 65 and older3 and has experienced a significant growth in all 50 states from 2000 to 2010.4 By 2050, it is projected that 15% or more of Social Security beneficiaries aged 62 or older will be Hispanic.3 Cross-cultural research with Latinos has shown that personal connections aid in the development of rapport and trust building, which are crucial for the dialogue surrounding palliative care, hospice, and EOL discussions.5 It is therefore essential to consider culturally specific
factors associated with EOL care for Latino patients and caregivers.6 End-of-life care delivery to Latinos is a well-documented challenge.7,8 The majority of caregivers for Latino patients are family relatives (ie, ‘‘la familia’’). Latino caregivers may spend 1
Division of Geriatrics Medicine, Saint Louis University, South Grand Blvd, St Louis, MO, USA 2 Department of Neurology & Psychiatry, Saint Louis University School of Medicine, St Louis, MO, USA 3 University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA 4 Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO, USA 5 Division of Geriatric Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA 6 GEC and GRECC, South Texas Veterans Health Care System, San Antonio, TX, USA 7 The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA Corresponding Author: Dulce M. Cruz-Oliver, MD, Division of Geriatrics, Department of Internal Medicine, Saint Louis University, 1402 South Grand Blvd M238, St Louis, MO 63104, USA. Email: [email protected]
Downloaded from ajh.sagepub.com at Bobst Library, New York University on November 14, 2015
American Journal of Hospice & Palliative Medicine®
2 more hours in the caregiving role than other ethnic groups9 and are less likely to use available health care services other than their own families10,11 because they think family members should provide the care.6 While common family values may change over time due to numerous factors, namely, acculturation, studies have shown that acculturation level does not influence Latino family caregivers’ decision-making preferences12 or service access.13 Many Latinos report preferences for limited patient autonomy and family-centered decision making, even when patients are able to make decisions by themselves.14 The combination of all these factors may result in Latinos not accessing EOL available resources because health care systems are not tailored toward their way of making decisions. This lack of health care access can expose caregivers to an increased burden and therefore make Latino elders more vulnerable to receive aggressive care. Education along with interventions centered on culturally related values may be needed to increase hospice use among Latinos.15 One study has shown that approaching Latino elders using a ‘‘novela or telenovela’’ may be a good method to communicate and educate them about health issues.15 A telenovela is usually a television show that narrates stories of few people intertwined into a dramatic plot; unlike soap operas, telenovelas are designed with an ending. Latinos are well known for liking telenovelas per Latino channels ratings.16 We developed an EOL bilingual education intervention for Latino caregivers, Caregivers Like Me, which uses a video soap opera (telenovela). Details of telenovela development will be published elsewhere, and in this article, we intend to report the testing of Caregivers Like Me ‘‘telenovela’’. The study aims to investigate whether educating Latinos using a telenovela can help decrease caregiver stress and improve their attitudes toward the utilization of EOL services.
Methods Study Design and Setting This is a multicenter, cross-sectional study of Latino caregivers from Puerto Rico (Arecibo, Jayuya, and San Juan: Hispanics of Puerto Rican descent), Texas (San Antonio: Hispanics of mostly Mexican descent), and Missouri (St Louis: Hispanics of mostly Central and South American descent). The Saint Louis University and University of Texas Health Science Center at San Antonio Institutional Review Boards approved this project.
Participant Recruitment Participants were volunteer caregivers of communitydwelling patients from Missouri, Texas, and Puerto Rico. Eligible study participants were nonprofessional caregivers aged 18 years and older who cared for a Latino elder. Community leaders at the study sites recruited participants using phone, e-mail, verbal announcements at church or lay congregations, and recruitment flyers. No compensation or incentive was
provided. Participants self-reported their ethnicity and Spanish proficiency.
Study Instruments Education tool, Telenovela. To explore Latino elders’ EOL care, we started with a literature review,5 which demonstrated that Latino elders face EOL decisions with family support and are receptive toward hospice if educated. Subsequently, we performed a needs assessment to study the gaps that exist in EOL care delivery,5 including the unknown need and acceptance of the hospice concept among Latinos. The needs assessment included focus groups with 45 hospice staff in Texas and Missouri and an experiential journal based on observations in hospice care in Puerto Rico. One solution suggested by participants was to provide education in Spanish done by religious leaders and to use media to promote EOL education and, specifically, to use a popular TV show format known as telenovelas or soap operas. Telenovelas are usually dramatic stories that aim to transmit sociocultural messages. Telenovelas are part of the Latino culture and are very popular to share among families and discuss crucial topics.17,18 The needs assessment results were used as a basis to develop an EOL education intervention for Latino caregivers. In particular, we decided to develop a bilingual (Spanish and English version) education intervention for Latino caregivers that included a video soap opera (‘‘telenovela’’), Caregivers Like Me. Details of telenovela development (ie, focus group results) will be published elsewhere, and in this article we intend to report the testing of Caregivers Like Me (telenovela). The education tool was a PowerPoint oral presentation that consisted of an introduction of session objectives, followed by the video presentation, and ending with a structured discussion. The structured discussion included definitions of hospice, palliative care, and caregiver stress and an explanation of services available for caregivers (ie, social services, support groups, adult day care, chore worker, home care with or without palliative care, and respite care under hospice). To minimize variation, all sessions were delivered by 1 of 2 researches (DC and JO) and a structured script was used to deliver the PowerPoint oral presentation. Figure 1 demonstrates the design of education tool. Education evaluation, pretest–posttest. A pretest–posttest design was done using Levels of Kirkpatrick19 to evaluate reaction and learning. In addition to the education intervention, participants were contacted by phone 4–7 months postintervention to evaluate their intention to change behavior. Pretest–posttest and phone survey questionnaire validation were done using a list of 12 questions that were created (by DC) and underwent field testing by 12 judges for content validity.20 These judges were a convenience sample of study researches (MP, TKM, SSR, JO, and NF) and potential participants from each study site (Puerto Rico, Texas, and Missouri) who did not participate in any of the sessions. The final pretest–posttest and phone survey questionnaire included 10 items.
Downloaded from ajh.sagepub.com at Bobst Library, New York University on November 14, 2015
Cruz-Oliver et al
3
Figure 1. Flowchart of education intervention development. After revising the literature and analyzing focus groups transcripts a video ‘‘telenovela’’ was created and then showed to family caregivers. The Kirkpatrick level of evaluation was used to create pretest–posttest questionnaire as well as the phone survey. Intervention was delivered in the following order: pretest, presentation, posttest, and discussion.
The instrument was designed to measure changes in attitude, knowledge, and satisfaction with experience. Participant attitudes were explored using 3 pretest–posttest questions to assess caregiver burden awareness, awareness of the need for help while being a caregiver for a loved one, and level of acceptance of help from 5 EOL services (social services, adult day care, chore worker, home care, and hospice). Response options for the attitude questions included 5 categories using a Likerttype rating scale (strongly disagree ¼ 1 to strongly agree ¼ 5). The same scale was used for 2 questions measuring the level of satisfaction with content (learning from video) and with the education format (overall experience). Participant knowledge was examined using 2 categories of questions: pretest items explored caregiver familiarity with 7 EOL terms (palliative care, caregiver burden, EOL care, hospice, home care, social work service, chore worker), and the posttest items explored their ability to correctly identify the same 7 EOL terms. Posttest knowledge questions regarding EOL were scored as correct for agree/strongly agree responses (eg, palliative care, caregiver burden, EOL care, home care, and chore worker) or for disagree/strongly disagree responses (ie, reverse scored for hospice and social work). A 4- to 7-month follow-up phone survey explored caregivers’ intention to use any of 4 EOL services (chore worker, palliative/hospice care, home care, or support groups). Demographic data included age (years), gender (male/female), education (years), marital status, religion, patient diagnosis, caregiver relationship with patient, caregiver health status, the Patient Health Questionnaire-2 (PHQ-2; range 0 to 6; interpretation higher than 3 is positive for depressive symptoms),21 and Short-Zarit Caregiver Burden Scale (range 0 to 16; interpretation more than 8 is suggestive for caregiver burden).22,23 We collected these data to obtain a profile of caregiver demographics and to explore whether caregiver characteristics are associated with pretest–posttest answers.
Educational Intervention Study sessions were done at community centers, mostly church congregations, and lasted approximately 1 hour. In total, 8 sessions were provided with a median of 17 participants in each group. A recruitment statement was bilingually read to participants at the start of the meeting. A hard copy (English or Spanish) was distributed to caregivers who agreed to participate. Participants completed the pretest and demographic questions (10 min) at the beginning of the meeting. The oral presentation was then delivered in person and included a 15-minute video (Spanish telenovela) and 15-minute structured discussion on topics related to EOL caregiver burden. Participants then completed a posttest questionnaire (10 min) to measures reaction, learning, and attitude changes after the intervention. Data were collected anonymously using hard copy questionnaires.
Data Analysis Demographic data were analyzed using descriptive statistics. Parametric (t tests, analysis of variance [ANOVA]) and nonparametric (chi-square) statistics were used to analyze evaluations of knowledge and attitudes. Sensitivity analyses were performed to examine association between caregivers’ characteristics (age, gender, education, health status, marital status, religion, diagnosis of patient, relationship with patient, PHQ2, and Short-Zarit Scale) and posttest responses in attitude questions. Data analyses were performed using IBM SPSS Statistics version 21.0 (Somers, New York).
Results Caregivers’ Characteristics Baseline characteristics for EOL caregivers are provided in Table 1. The sample included N ¼ 145 Latinos who were
Downloaded from ajh.sagepub.com at Bobst Library, New York University on November 14, 2015
American Journal of Hospice & Palliative Medicine®
4 Table 1. Sample Baseline Characteristics.
Siteb Variablea Female, % Age, mean+ SD Education, % Elementary school High school College More than college Religion, % Christian (non-Catholic) Catholic Other Marital status, % Married Single Divorced or separated Widowed Relationship to patient, % Parents Siblings Children Other Patient diagnosis, % Heart disease Dementia Diabetes Cancer Hypertension Stroke Arthritis Self-rated health Poor-fair, % PHQ-2, score 3 (positive for depression),% Short Zarit Scale, score 8 (positive for burden), %
Total N ¼ 145
PR N ¼ 92
MO N ¼ 15
TX N ¼ 38
P-valuec
79 56+15
79 52+14
67 45+13
84 71+8
.367
