Background: The aim of this study was to validate the Caregiver Reaction Assessment (CRA) among caregivers of community-dwelling advanced cancer patients in Japan. Methods: A cross-sectional questionnaire was administered to advanced cancer patients and their caregivers who were cared for at day hospices and home palliative care services. We translated the CRA into Japanese, and then verified factor validity, reliability, construct validity, concurrent validity, and known groups’ validity. To address construct and concurrent validity, we calculated Pearson’s correlation coefficient between the Japanese version of the CRA and the Burden Index of Caregivers (BIC). To address known groups’ validity, we used the t test or analysis of variance (ANOVA). Results: A total of 57 caregivers participated in the study. Five factors were extracted (‘‘impact on schedule,’’ ‘‘caregiver’s self-esteem,’’ ‘‘lack of family support,’’ ‘‘impact on health,’’ and ‘‘impact on finances’’) and reliability was good. Construct and concurrent validity among the subscales of the BIC were good. Regarding known groups validity, the subscale score of ‘‘impact on schedule’’ for the groups that cared 6 hours or more per day was higher than the other group (P = .04). Conclusion: The CRA-J is valid and reliable. This scale is useful for caregivers of cancer patients in Japan.
Health, Labor and Welfare Ministry.National census. http://www.dbtk.mhlw.go.jp/toukei/data/010/2006/toukeihyou/0006087/t0135628/MC220000_001.html. Accessed January 5, 2008.
2.
Japan HPC.Hospice Palliative Care Japan survey in 2006. Hospice Palliative Care Japan Annual Conference in 2007, Nagano; 2007:112-116.
3.
Foreman LM, Hunt RW, Luke CG, Roder DMFactors predictive of preferred place of death in the general population of South Australia. Palliat Med. 2006;20(4): 447-453.
4.
Gott M., Seymour J., Bellamy G., Clark D., Ahmedzai S.Older people’s views about home as a place of care at the end of life . Palliat Med. 2004;18(5):460-467.
5.
Thomas C., Morris SM, Clark D.Place of death: preferences among cancer patients and their carers. Soc Sci Med. 2004;58(12):2431-2444.
6.
Goodwin DM, Higginson IJ, Myers K., Douglas H-R., Normand CEEffectiveness of palliative day care in improving pain, symptom control, and quality of life. J Pain Symptom Manage. 2003 ;25(3):202-212.
7.
Lee L.Interprofessional working in hospice day care and the patients’ experience of the service. Int J Palliat Nurs. 2002;8(8):389-400.
8.
Hopkinson JB , Hallett CEPatients’ perceptions of hospice day care: a phenomenological study. Int J Nurs Stud. 2001;38(1):117-125.
9.
Lohfeld LH, Tschopp AS, Trevor AW, Brazil K., Krueger P.Assessing the need for and potential role of a day hospice: a qualitative study. J Palliat Care. 2000;16(4):5-12.
10.
Spencer DJ, Daniels LEDay hospice care-a review of the literature. Palliat Med. 1998;12(4):219-229.
11.
Langley-Evans A., Payne S.Light-hearted death talk in a palliative day care context. J Adv Nurs. 1997;26(6): 1091-1097.
12.
Sharma K., Oliver D., Blatchford G., Higginbottom P., Khan V.Medical care in hospice day care. J Palliat Care. 1993;9(3):42-43.
13.
Arai Y., Kudo K., Hosokawa T., Washio M., Miura H., Hisamichi S.Reliability and validity of the Japanese version of the Zarit Caregiver Burden Interview. Psychiatry Clin Neurosci. 1997;51(5):281-287.
14.
Abe K.Reconsidering the Caregiving Stress Appraisal scale: validation and examination of its association with items used for assessing long-term care insurance in Japan. Arch Gerontol Geriatr. 2007;44(3):287-297.
15.
Kuzuya M., Masuda Y., Hirakawa Y., et al. Falls of the elderly are associated with burden of caregivers in the community. Int J Geriatr Psychiatry. 2006;21(8):740-745.
16.
Schreiner AS , Morimoto T., Arai Y., Zarit S.Assessing family caregiver’s mental health using a statistically derived cut-off score for the Zarit Burden Interview . Aging Mental Health. 2006;10(2):107-111.
17.
Onishi J., Suzuki Y., Umegaki H., Nakamura A., Endo H., Iguchi A.Influence of behavioral and psychological symptoms of dementia (BPSD) and environment of care on caregivers’ burden. Arch Gerontol Geriatr. 2005;41(2): 159-168.
18.
Kumamoto K. , Arai Y.Validation of ‘personal strain’ and ‘role strain’: subscales of the short version of the Japanese version of the Zarit Burden Interview (J-ZBI_8). Psychiatry Clin Neurosci. 2004;58(6):606-610.
19.
Morimoto T. , Schreiner AS, Asano H.Caregiver burden and health-related quality of life among Japanese stroke caregivers. Age Ageing. 2003;32(2):218-223.
20.
Miyamoto Y. , Ito H., Otsuka T., Kurita H.Caregiver burden in mobile and non-mobile demented patients: a comparative study. Int J Geriatr Psychiatry . 2002;17(8):765-773.
21.
Arai Y., Zarit SH, Sugiura M., Washio M.Patterns of outcome of caregiving for the impaired elderly: a longitudinal study in rural Japan. Aging Mental Health. 2002; 6(1):39-46.
22.
Kim Y., Schulz R., Carver CSBenefit-finding in the cancer caregiving experience. Psychosom Med. 2007;69(3): 283-291.
23.
Pinquart M. , Sorensen S.Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison . Aging Mental Health. 2004;8(5):438-449.
24.
Hunt CKConcepts in caregiver research. J Nurs Scholarsh. 2003;35(1):27-32.
25.
Cohen CA, Colantonio A., Vernich L.Positive aspects of caregiving: rounding out the caregiver experience. Int J Geriatr Psychiatry. 2002;17(2):184-188.
26.
Kramer BJGain in the caregiving experience: where are we? What next?Gerontologist. 1997;37(2):218-232.
27.
Langner SRFinding meaning in caring for elderly relatives: loss and personal growth . Holist Nurs Pract. 1995;9(3):75-84.
28.
Bachner YG, O’Rourke N., Carmel S.Psychometric properties of a modified version of the Caregiver Reaction Assessment Scale measuring caregiving and post-caregiving reactions of caregivers of cancer patients. J Palliat Care. 2007;23(2):80-86.
29.
Grov EK, Fossa SD, Sorebo O., Dahl AAPrimary caregivers of cancer patients in the palliative phase: a path analysis of variables influencing their burden. Soc Sci Med. 2006;63(9):2429-2439.
30.
Grov EK, Fossa SD, Tonnessen A., Dahl AAThe caregiver reaction assessment: psychometrics, and temporal stability in primary caregivers of Norwegian cancer patients in late palliative phase. Psychooncology. 2006;15(6):517-527.
31.
Jepson C., McCorkle R., Adler D., Nuamah I., Lusk E.Effects of home care on caregivers’ psychosocial status. Image J Nurs Sch. 1999;31(2):115-120.
32.
Nijboer C., Triemstra M., Tempelaar R., Sanderman R., van den Bos GAMeasuring both negative and positive reactions to giving care to cancer patients: psychometric qualities of the Caregiver Reaction Assessment (CRA). Soc Sci Med. 1999;48(9):1259-1269.
33.
Nijboer C., Triemstra M., Tempelaar R., Sanderman R., van den Bos GADeterminants of caregiving experiences and mental health of partners of cancer patients. Cancer. 1999;86(4):577-588.
34.
Given CW, Given B., Stommel M., Collins C., King S., Franklin S.The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairments. Res Nurs Health. 1992;15(4):271-283.
35.
Miyashita M. , Yamaguchi A., Kayama M., et al. Validation of the Burden Index of Caregivers (BIC), a multidimensional short care burden scale from Japan. Health Qual Life Outcomes. 2006;4:52.
36.
Hanratty B. , Holland P., Jacoby A., Whitehead M.Financial stress and strain associated with terminal cancer- a review of the evidence. Palliat Med. 2007;21(7): 595-607.
37.
Giorgi Rossi P., Beccaro M., Miccinesi G., et al. Dying of cancer in Italy: impact on family and caregiver. The Italian Survey of Dying of Cancer. J Epidemiol Community Health. 2007;61(6):547-554.
38.
Longo CJ, Fitch M., Deber RB, Williams APFinancial and family burden associated with cancer treatment in Ontario, Canada . Support Care Cancer. 2006;14(11): 1077-1085.
39.
Grunfeld E. , Coyle D., Whelan T., et al. Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers. [see comment]. CMAJ. 2004;170(12):1795-1801.
40.
Hwang SS, Chang VT, Cogswell J., et al. Study of unmet needs in symptomatic veterans with advanced cancer: incidence, independent predictors and unmet needs outcome model. J Pain Symptom Manage. 2004;28(5): 421-432.
41.
Tilden VP, Tolle SW, Drach LL, Perrin NAOut-of-hospital death: advance care planning, decedent symptoms, and caregiver burden. J Am Geriatr Soc. 2004; 52(4):532-539.
42.
Emanuel EJ, Fairclough DL, Slutsman J., Emanuel LLUnderstanding economic and other burdens of terminal illness: the experience of patients and their caregivers. Ann Intern Med. 2000;132(6):451-459.
