Dyadic Analysis of Unmet Social Needs Among Breast and Gynecologic Patients and Their Informal Caregivers

乳腺和妇科患者及其非正式护理人员未满足的社会需求的二元分析

• 批准号: 10587457
• 负责人: Tess Thompson
• 金额: $ 2.73万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-19 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10587457
• 关键词: Academy; Address; Adherence; Affect; Anxiety; Area; Breast; Cancer Patient; Caregivers; Caring; Censuses; Characteristics; Communities; Diagnosis; Distress; Education; Emergency department visit; Emotional; Family member; Female; Food; Friends; Geography; Goals; Gynecologic; Health; Health system; Housing; Income; Individual; Intervention; Interview; Link; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Measures; Mental Health; Modeling; Neighborhoods; Newly Diagnosed; Outcome; Participant; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Population; Poverty; Quality of Care; Quality of life; Race; Reduce health disparities; Reporting; Research; Resources; Self Management; Social Conditions; Social Environment; Socioeconomic Status; Structure; System; Testing; Time; Transportation; United States; Woman; Work; biopsychosocial; cancer diagnosis; care outcomes; depressive symptoms; deprivation; experience; food insecurity; health disparity; improved; improved outcome; indexing; individual patient; informal caregiver; informal caregiving; interest; malignant breast neoplasm; member; men; mortality; physical conditioning; preference; primary outcome; psychological distress; residence; screening; secondary outcome; social; social health determinants; social vulnerability; socioeconomic disadvantage; treatment adherence; visit adherence

PROJECT SUMMARY/ABSTRACT Psychological distress is prevalent in cancer patients and their informal caregivers (the intimate partners, other family members, and friends who provide patients with crucial unpaid care and support). Distress has been linked to poorer adherence to treatment and elevated mortality in patients, as well as negative outcomes for caregivers. Whether patients or caregivers, women tend to report greater distress than men. Research on patient-caregiver dyads has shown patients' and caregivers' physical and mental health is often intertwined, but most prior dyadic work has analyzed predominantly middle-class spousal pairs. Given the persistent effects of poverty and the longstanding health disparities by socioeconomic status in the United States, it is crucial to understand the social context of financially vulnerable cancer patients and caregivers. Individual social needs—including food, housing, or transportation—are associated with distress as well as physical health outcomes in a range of contexts and populations. A growing body of research has analyzed single social needs—most commonly food insecurity—among cancer patients in particular, but little is known about multiple social needs in patients, how needs change over time, and whether the social needs of informal caregivers affect patient outcomes. This study focuses on female patients with breast and gynecologic cancer—which together account for over 400,000 newly diagnosed cancers among women annually—and their informal caregivers. Our aims are: Aim 1. Document unmet social needs in patient-caregiver dyads (N = 300 dyads). Analyze how needs affect patient and caregiver biopsychosocial outcomes including depressive symptoms (primary outcome), physical and mental health quality of life, emergency department (E.D.) visits, and treatment adherence (secondary outcomes). Aim 2. Analyze the experiences of patients and caregivers with unmet social needs and explore their interest in and preferences for mental health and social needs intervention. Use semi-structured dyadic interviews with 30 patient-caregiver pairs (N = 60 total participants) in which one member reports at least one unmet need at baseline to explore participants' use of community resources, whether they coordinate with the other member of the dyad to resolve unmet social needs, and their preferences for screening and intervention. Aim 3. Explore the relationship between neighborhood-level factors (census tract Area Deprivation Index and 2-1-1 helpline requests by ZIP code), social needs, and depressive symptoms within dyads. This study will provide first-of-its-kind information about the biopsychosocial effects of unmet social needs among female patients with cancer and their caregivers. A central question is whether and how caregivers' social needs affect the patient. The answer will help us create a targeted screening and intervention system to address the mental health and social needs of patients, and, if warranted, caregivers. Our ultimate goal is to improve outcomes for women with cancer and their caregivers.

项目摘要/摘要 心理困扰在癌症患者及其非正式护理人员中普遍存在（亲密伴侣，其他 家庭成员和朋友为患者提供至关重要的无薪护理和支持）。困扰已经 与患者对治疗和死亡率较高的依从性较差以及负面结果有关 照顾者。无论是患者还是看护人，女性都会报告比男性更大的困扰。研究 患者照顾者的二元组表明患者的身心健康经常交织在一起， 但是大多数先前的二元工作主要分析了中产阶级配偶对。鉴于持续的效果 贫困和长期存在的健康差异是美国的社会经济地位，这对 了解财务上脆弱的癌症患者和看护人的社会环境。个人社会 需求（包括食物，住房或运输）与困扰以及身体健康有关 在各种环境和人群中的结果。越来越多的研究分析了单一社会 需求 - 通常是粮食不安全的 - 尤其是癌症患者，但对多种的了解知之甚少 患者的社会需求，需求如何随着时间而变化以及非正式护理人员的社会需求是否 影响患者的结果。这项研究的重点是乳腺癌和妇科癌症患者 年度妇女及其非正式 照顾者。我们的目标是：AIM 1。记录患者保养者二元组中未满足的社会需求（n = 300个二元组）。 分析需求如何影响患者和护理人员生物心理社会结局，包括抑郁症状 （主要结果），身心健康生活质量，急诊科（E.D.）访问以及 治疗依从性（次要结果）。目标2。分析患者和照顾者的经历 未满足的社会需求并探索他们对心理健康和社会需求的兴趣和偏好 干涉。使用30个患者护理人对（n = 60个参与者）的半结构二元访谈 一位成员在基线时至少报告了一个未满足的需求，以探索参与者对社区的使用 资源，是否与二元组的其他成员协调以解决未满足的社会需求及其 筛查和干预的偏好。目标3。探索邻里级别之间的关系 因素（人口普查区域剥夺指数和邮政编码的2-1-1求助热线要求），社会需求和 二元组中的抑郁症状。这项研究将提供有关 女性癌症及其护理人员未满足社会需求的生物心理社会影响。一个 中心问题是照顾者的社会需求是否以及如何影响患者。答案将帮助我们创建 有针对性的筛查和干预系统，以满足患者的心理健康和社会需求，如果 保证，护理人员。我们的最终目标是改善癌症女性及其护理人员的结果。