• Siew T Tang, Chi C J Cheng, Kwo C Lee, Chen H Chen, and Li N Liu.
• Author Affiliations: Graduate School of Nursing (Dr Tang), Chang Gung University, Tao-Yuan; Departments of Public Health (Dr Cheng) and Nursing (Dr Liu), Fu-Jen Catholic University, Taipei; School of Nursing (Dr Lee), China Medical University, Taichung; Department of Nursing, Kang-Ning Junior College of Medical Care and Management (Ms Chen), Taipei, Republic of China.
• Cancer Nurs. 2013 Nov 1;36(6):E25-33.

BackgroundThe stress and coping theory suggests that the impact of caregiving on caregivers' life depends more on personal psychological resources (ie, sense of coherence [SOC]) than on objective caregiving demands or social resources. However, SOC's mediation roles in helping caregivers cope with the challenges of end-of-life care have never been explored.ObjectiveThe objective of this study was to evaluate the mediation effects of SOC on caregivers' depressive distress while providing end-of-life care.MethodsThe Center for Epidemiological Studies-Depression Scale scores from a convenience sample of 621 family caregivers were analyzed using structural equation modeling. We used the Sobel test to verify the significance of SOC's mediation effects on the relationships between identified stressors (objective caregiving demands, patient symptom distress), appraisals (confidence in caregiving, subjective caregiving burden), and caregivers' depressive distress.ResultsSense of coherence mediated effects on relationships between Center for Epidemiological Studies-Depression Scale scores and subjective caregiving burden (P = .000), confidence in caregiving (P = .014), and objective caregiving demands (P = .000). Although the strength of SOC did not attenuate the impact of caregivers' perceived patient symptom distress on caregiver depressive distress, SOC mediated this effect secondarily through appraisals of subjective caregiving burden and confidence in caregiving.ConclusionPersonal psychological resources, as indicated by the strength of personal SOC, significantly mediated the effects of caregiving stressors, appraisals of caregiving confidence, and subjective caregiving burden on depressive distress of family caregivers while providing end-of-life care.Implications For PracticeNursing interventions to enhance caregivers' SOC may decrease their depressive distress through increasing their confidence in providing end-of-life care and lightening their perceived caregiving burden.

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