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Mount Sinai, NY, United States

Glajchen M.,Beth Israel Deaconess Medical Center | Homel P.,Maimonides Medical Center | Tsoi C.Y.,Beth Israel Deaconess Medical Center | Chan S.,Asian Services Center | Portenoy R.,Beth Israel Deaconess Medical Center
Journal of Palliative Medicine | Year: 2013

Background: Chinese family caregivers in the United States experience high rates of burden. Studies in this population require culturally appropriate and valid instruments. Objective: To adapt a Chinese version of the Brief Assessment Scale for Caregivers (BASC), a tool measuring positive and negative effects of caregiving. Methods: New items for the Chinese adaptation were generated from the literature, an interdisciplinary professional group, and caregiver focus groups. The new items were translated into Chinese, added to the original 14-item BASC, then administered to caregivers in two surveys (n=205); participants also completed Chinese versions of the Caregiver Burden Inventory-Chinese (CBI-C), the Hospital Anxiety and Depression Scale (HADS), and the Katz Index for Activities of Daily Living. Item reduction and exploration of internal consistency, reliability and validity using correlational, exploratory, and confirmatory factor analysis were performed. Results: Factor analysis and item-total correlations supported reduction in the number f new items. The final BASC-Chinese (BASC-C) included 10 new items plus the 14 items from the original tool with an overall α coefficient of 0.79 for the 24-item scale. Three Chinese-specific factors -cultural strain, decision-making strain, and emotional strain - showed α coefficients of 0.69 to 0.79. Significant first order correlations were found between the BASC-C and previously validated measures (total BASC-C with HADS Anxiety [r=0.64, p<0.001], HADS Depression [r=0.60, p<0.001], and CBI-C [r=0.60, p<0.001]). Partial correlations indicated that the new Chinese items provided information supplemental to the original BASC. Conclusion. This study suggests that the BASC-C is a valid measure of caregiver burden among Chinese family caregivers. © Copyright 2013, Mary Ann Liebert, Inc. 2013.

Dhingra L.,Yeshiva University | Lam K.,Asian Services Center | Homel P.,Continuum Care | Chang V.T.,Rutgers University | And 4 more authors.
Oncologist | Year: 2011

Background. Little is known about cancer pain in Chinese Americans. The objective of this study was to describe the epidemiology of pain in this population. This information is needed to identify and address unmet clinical needs for culturally relevant interventions targeting pain and its consequences. Methods. A consecutive sample of underserved ethnic Chinese patients in a large community-based oncology practice was screened for persistent or frequent pain. Those patients with pain completed translated instruments assessing demographics, linguistic acculturation, disease-related characteristics, and pain-related characteristics. Results. Of 312 patients screened, 178 (57.1%) reported frequent or persistent pain, 175 were eligible, and 170 participated. Most participants (85.9%) were born in China and 84.7% overall spoke Cantonese only. The most common cancers were gastrointestinal (28.2%), lung (21.8%), breast (20.6%), head and neck (12.9%), and genitourinary (4.7%); 43.5% had metastatic disease. The mean worst pain severity on a 0-10 numeric scale was 4.7 (standard deviation, 2.4), with 28.2% of patients rating their worst pain at>7 of 10. Although 37.6% used opioids and 47.1% used nonopioids, 45.8% reported "little" or "no" pain relief from medications. Complementary or alternative medicine therapies for cancer pain were used by 35.8%. In multiple regression analyses, worst pain was positively associated with acculturation to the English language and opioid therapy, and pain-related distress was positively associated with opioid therapy. Conclusion. Pain is prevalent among community dwelling, ethnic Chinese American cancer patients. Additional studies are needed to confirm these results and investigate the finding that higher linguistic acculturation is associated with reports of more intense pain.

Dhingra L.K.,MJHS Institute for Innovation in Palliative Care | Lam K.,Community Oncology ProgramAsian Services Center | Cheung W.,Private Practice | Shao T.,Mount Sinai Beth Israel Comprehensive Cancer Center | And 15 more authors.
Cancer | Year: 2015

BACKGROUND: Cancer is prevalent in the rapidly growing Chinese American community, yet little is known about the symptom experience to guide comprehensive treatment planning. This study evaluated symptom prevalence and patient subgroups with symptom distress in a large sample of Chinese American cancer patients. METHODS: Patients were consecutively recruited from 4 oncology practices, and they completed a translated cancer symptom scale. Latent class cluster analysis was used to identify subgroups of patients with distinct symptom distress profiles. RESULTS: There were 1436 patients screened; 94.4% were non-English-speaking, and 45.1% were undergoing cancer therapy. The cancers included breast (32.6%), lung (14.8%), head and neck (12.5%), and hematologic cancer (10.1%). Overall, 1289 patients (89.8%) had 1 or more symptoms, and 1129 (78.6%) had 2 or more. The most prevalent symptoms were a lack of energy (57.0%), dry mouth (55.6%), feeling sad (49.3%), worrying (47.5%), and difficulty sleeping (46.8%). Symptoms causing "quite a bit" or "very much" distress included difficulty sleeping (37.9%), a lack of appetite (37.2%), feeling nervous (35.8%), pain (35.2%), and worrying (34.0%). Four patient subgroups were identified according to the probability of reporting moderate to high symptom distress: very low physical and psychological symptom distress (49.5%), low physical symptom distress and moderate psychological symptom distress (25.2%), moderate physical and psychological symptom distress (17.4%), and high physical and psychological symptom distress (7.8%). CONCLUSIONS: Symptom prevalence is high in community-dwelling Chinese American cancer patients, and nearly half experience severe distress (rated as "quite a bit" or "very much" distressing) from physical symptoms, psychological symptoms, or both. These data have important implications for the development of effective symptom control interventions. Cancer 2015. © 2015 American Cancer Society. © 2015 American Cancer Society.

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