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Family caregivers of advanced cancer patients: self-perceived competency and meaning-making
  1. Irene Teo1,2,3,
  2. Drishti Baid1,
  3. Semra Ozdemir1,3,
  4. Chetna Malhotra1,3,
  5. Ratna Singh1,
  6. Richard Harding4,
  7. Rahul Malhotra3,5,
  8. Meijuan Grace Yang1,2,
  9. Shirlyn Hui-Shan Neo2,
  10. Yin Bun Cheung3,6,7,
  11. Patricia Soek Hui Neo2,
  12. Ravindran Kanesvaran8,
  13. Nesaretnam Barr Kumarakulasinghe9,
  14. Lai Heng Lee10,
  15. Gerald Choon Huat Koh3,11 and
  16. Eric A Finkelstein1,3
  17. COMPASS study group
  1. 1Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
  2. 2Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
  3. 3Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore
  4. 4Department of Palliative Care and Policy, King's College London, London, UK
  5. 5Centre for Aging Research and Education, Duke-NUS Medical School, Singapore
  6. 6Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
  7. 7Center for Child Health Research, Tampere University, Tampere, Pirkanmaa, Finland
  8. 8Division of Medical Oncology, National Cancer Centre Singapore, Singapore
  9. 9National University Cancer Institute, National University Health System, Singapore
  10. 10Department of Haematology, Singapore General Hospital, Singapore
  11. 11Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  1. Correspondence to Dr Irene Teo, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 169547, Singapore; irene.teo{at}


Background Family caregivers of patients with advanced cancer have been reported to provide long hours of care and be at risk for poor psychological outcomes. Although research has focused on the nature of caregiving burden, little attention has been paid to identifying protective factors that improve caregiver psychological outcomes.

Aim We examined the relationship between caregivers’ time spent caregiving and the following psychological outcomes: anxiety, depression and caregiving esteem. Subsequently, we explored the main and moderating effects of caregiver-perceived self-competency and sense of meaning on caregiver psychological outcomes.

Design/participants Cross-sectional analysis was conducted using the baseline data from an ongoing cohort study. Family caregivers of advanced cancer patients (n=287) were recruited from two tertiary hospitals in Singapore.

Results Time spent caregiving was not significantly associated with caregiver anxiety, depression or caregiving esteem. However, significant main effects of self-competency on anxiety and caregiving esteem; and sense of meaning on anxiety, depression and caregiving esteem were observed. Moderator analyses further indicated that self-competency attenuated the positive relationship between time spent caregiving and anxiety, while sense of meaning attenuated the negative relationship between time spent caregiving and caregiving esteem.

Conclusion Greater perceived self-competency and sense of meaning are related to better caregiver psychological outcomes, and protect caregivers from worsening outcomes as caregiving hours increase. Our findings suggest that screening caregivers for distress is an important part of care, and that supportive interventions for caregivers should aim to enhance their perceived caregiving competencies and the ability to make meaning of their caregiving role.

  • caregivers
  • cancer
  • anxiety
  • depression
  • meaning-making
  • competency
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  • Contributors IT, SOVD, CM, RS, YBC and EF were involved in study planning. IT, RS, GMY, PSHN, RK, NBK and LHL were involved in study conduct. IT, DB and RS led to the preparation of the manuscript. All authors were involved in the reporting and reviewing of the manuscript.

  • Funding The study is funded by Singapore Millennium Foundation (2015-SMF-0003) and Lien Centre for Palliative Care (LCPC-IN14-0003).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved and is being monitored by the SingHealth Centralised Institutional Review Board (Ref: 2015/2781).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available from the

    corresponding author upon reasonable request.

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