Psychoeducation for BMT caregivers: Biobehavioral markers and outcome

BMT 护理人员的心理教育：生物行为标记和结果

• 批准号: 8254293
• 负责人: Mark L. Laudenslager
• 金额: $ 49.53万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-06-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8254293
• 关键词: Address; Adult; Affect; Allogenic; American; Anxiety; Behavior assessment; Behavioral; Biofeedback; Biological Markers; Blood; Cancer Patient; Cancer Survivorship; Caregivers; Caring; Characteristics; Circadian Rhythms; Communities; Control Groups; Devices; Diagnosis; Distress; Educational process of instructing; Endocrine; Equilibrium; Family; Health; Hour; Household; Hydrocortisone; Immune; Immunologic Markers; Intervention; Intervention Studies; Literature; Marrow; Measures; Medical; Medical Care Costs; Mental Depression; Mental Health; National Cancer Institute; Neurosecretory Systems; Outcome; Patient Care; Patients; Process; Randomized; Randomized Controlled Trials; Recovery; Regulation; Research; Respiration; Role; Salivary; Sampling; Sleep; Source; Stress; Surgeon; Testing; Training; Transplant Recipients; Transplantation; Well in self; Work; biobehavior; caregiving; cytokine; cytotoxicity; dehydroepiandrosterone; design; experience; facial transplantation; graft vs host disease; loved ones; member; mind body interaction; outcome forecast; physical conditioning; programs; psychoeducation; response; stress management; tool; treatment as usual

DESCRIPTION (provided by applicant): This resubmission is in response to PA-07-046, "Research on mind body interactions and health." The National Cancer Institute is particularly concerned about cancer survivorship in which the caregiver is viewed as an integral component of the patient's recovery process. The number of adult caregivers exceeded 5.9 million in 2000, affecting over 22.4 million households in the US. Although caregivers may reduce medical care costs of the patient, the impact on the caregiver is substantial leading to lost work, financial burden, and increased medical and mental health problems. There is an extensive literature on the impact of caregiving on psychological well being, immune regulation, and neuroendocrine balance. Perturbations in these basic homeostatic processes have long term health consequences for the caregivers. Caregivers of patients receiving allogeneic blood and marrow transplants (BMT) are faced with a stressful experience marked by uncertainly and the likelihood of iatrogenic illness in the patient such as graft versus host disease associated with BMT. Approval for an allogeneic BMT requires the presence of a 24 hour caregiver for at least 100 days and quite often longer. Although a number of interventions have targeted the cancer patient, there have been few that have focused on the caregiver cancer patients and even fewer that have followed biomarkers in association with these interventions. Stress management and psychoeducation has been demonstrated as useful when dependent variables include behavioral markers. However many intervention studies have used convenience samples, failed to randomize treatments, did not include control groups for comparison purposes, or omitted biomarkers. The present study proposes a randomized control trial with intent to treat of BMT patient caregivers assigned to either treatment as usual or individualized stress management psychoeducation that includes a biofeedback device for training paced respiration which also tracks compliance. Dependent measures include caregiver and patient health, immune and endocrine markers, sleep characteristics via actimetry, and behavioral assessments of stress, depression, anxiety, and burden. This unique stress management psychoeducation intervention is expected to have positive effects on biomarkers of caregiver physical and psychological health including sleep, immune markers (natural cytotoxicity and Type 1 and 2 cytokine balance), and endocrine markers (diurnal variations in salivary cortisol and DHEA) compared to treatment as usual. This intervention focuses on needs of caregivers raised by the Surgeon General's Rx for caregivers at fundamental levels by 1) addressing issues around depression and anxiety, 2) identifying sources of support within the community for the caregivers, 3) focusing on the role of the caregiver's own health in their care of the patient, 4) sensitizing the caregivers to their stress and its effects on them, 5) teaching the caregiver about the illness their loved one is experiencing, and 6) providing stress management tools.

描述（由申请人提供）：此重新提交是对PA-07-046的回应，“关于身体互动和健康的研究”。国家癌症研究所特别关注癌症的生存，其中护理人员被视为患者康复过程中不可或缺的组成部分。在2000年，成人护理人员的数量超过590万，在美国影响了2240万家庭。尽管护理人员可能会降低患者的医疗费用，但对看护人的影响是实质性的，导致工作失去，经济负担以及增加医疗和心理健康问题。有关于护理对心理健康，免疫调节和神经内分泌平衡的影响的广泛文献。这些基本的体内稳态过程中的扰动对护理人员产生了长期的健康后果。接受同种异体血液和骨髓移植（BMT）的患者的护理人员面临着不确定的压力经历，患者在患者中的医源性疾病可能性以及与BMT相关的宿主疾病等患者的可能性。同种异体BMT的批准需要至少100天的24小时护理人员存在，而且经常更长。尽管许多干预措施针对癌症患者，但很少有人专注于护理人员癌症患者，甚至更少的是与这些干预措施相关的生物标志物。当因变量包括行为标记时，压力管理和心理教育已被证明是有用的。然而，许多干预研究都使用了便利样本，未能随机治疗，不包括用于比较目的的对照组或省略生物标志物。本研究提出了一项随机对照试验，意图治疗像往常或个性化压力管理心理教育的BMT患者护理人员，其中包括用于训练节奏呼吸的生物反馈设备，该设备也跟踪合规性。依赖措施包括护理人员和患者健康，免疫和内分泌标记，通过行动法进行睡眠特征，以及对压力，抑郁，焦虑和负担的行为评估。与惯用治疗相比，这种独特的压力管理心理教育干预措施预计将对护理人员身体和心理健康的生物标志物具有积极影响，包括睡眠，免疫标记（自然细胞毒性以及1型和2型细胞因子平衡）和内分泌标记物（唾液皮质醇和DHEA中的昼夜变化）与惯用治疗相比。这项干预措施着重于外科医生RX在基本层面上提高的护理人员提出的护理人员的需求1）解决有关抑郁症和焦虑症的问题，2）确定社区内为照料者提供支持的来源，3）专注于照顾者对自己的健康护理中的护理人员的角色，4）对他们的压力和疾病的敏感，4）教育者，5）教育者，5）5） 6）提供压力管理工具。