Cancer Caregivers and Their Struggle(s) between Work and Family

此应用程序是对FOA的响应，即通过与癌症护理人员进行干预来改善患者健康 结果和优化卫生保健利用“(PAR-16-317)，我们在其中专门解决了 照顾者(CG)和他们的配偶或伴侣癌症患者。六千六百万美国人照顾残疾人 2015年，癌症患者的CGs约占所有CGs的17%。巨蟹座的CGs 比其他疾病的CGS更苦恼。为以下人群提供的支持性干预措施最低限度 在治疗期间和治疗后对癌症患者的护理是一个重要的服务差距。 此外，受雇的癌症CG必须管理多重责任(即所谓的“三明治” 一代人“)，同时仍在照顾他们所爱的人。CGs可能需要继续雇用CG以 为家庭提供收入来源和/或健康保险。专门针对压力的干预措施 对癌症CGs的管理没有纳入受雇CGs的独特需求，跟踪CG的医疗保健 利用度以及情感和生理健康。我们将测试一个循证的影响(S) 加强对有较大痛苦的受雇警员的心理社会压力管理干预 与常规治疗(TAU)相比，CG医疗保健对他们的抑郁症(CG的主要结果) 利用，和慢性压力的生物标志物。我们将允许CG根据需要进行选择，以减轻CG负担 三种内容相似的有效方式(一对一、视频聊天或基于网络) 管理层干预。这种方法允许CG更灵活地参与干预 从而提高依从性。我们将测试CG参与干预的程度 与TAU相比，TAU还会影响患者的症状管理、痛苦和患者保健 利用率。情绪困扰将使用可靠的心理抑郁、焦虑、 以及对CG和患者的压力。医疗保健利用率将同时使用自我报告和 可用的电子系统，指南针。指南针包括药房使用、实验室结果、医生 相遇、住院和其他信息也在电子病历中。这项研究将填补一个 我们对为改善健康结果而加强干预措施的理解存在重大差距 与TAU相比，无论是对他们自己还是对他们的患者都是如此。

This application is in response to FOA “Intervening with cancer caregivers to improve patient health outcomes and optimize heath care utilization” (PAR-16-317) in which we specifically address employed caregivers (CG) and their spousal or partnered cancer patient. Sixty-six million Americans cared for a disabled or ill person in 2015 while CGs of cancer patients represented about 17% of all CGs. Cancer CGs are more distressed than CGs of other medical disorders. Minimal availability of supportive interventions for CGs who care for those with cancer during treatment and afterwards represents an important service disparity. Furthermore, employed cancer CGs must manage multiple responsibilities (the so-called “sandwich generation”) while still caring for their loved-one. Continued employment of the CG may be required for CGs to provide a source of income and/or health insurance for the family. Interventions specifically addressing stress management for cancer CGs have not incorporated unique needs of employed CGs, tracked CG's healthcare utilization as well as emotional and physiological wellbeing. We will test the influence(s) of an evidence-based psychosocial stress management intervention enhanced for employed CGs preselected for greater distress compared to treatment as usual (TAU) on their depression (the CG primary outcome), CG healthcare utilization, and biomarkers of chronic stress. We will allow CGs to select as desired to reduce CG burden from three effective modalities (one-on-one, video chat, or web-based) similar in content as their stress management intervention. This approach allows greater flexibility for the CG to participate in the intervention and thus improve adherence. We will test the extent to which the CG's participation in the intervention compared to TAU also influences the patient's symptom management, distress, and patient healthcare utilization. Emotional distress will be measured using reliable self-reports of psychological depression, anxiety, and stress for both the CG and the patient. Healthcare utilization will use both self-report alongside an available electronic system, COMPASS. COMPASS includes pharmacy use, laboratory results, physician encounters, hospitalizations, and other information also in the electronic medical record. This study will fill an important gap in our understanding of an intervention enhanced for working CGs on improved health outcomes both for themselves as well as for their patient compared to TAU.