BREAST CANCER PATIENTS RELATIVES--RESPONSE OVER TIME

针对癌症风险较高或接受程度较高的人群传递信息，可以提高预防和早期发现工作的效率和效果。癌症患者的亲属在接近诊断时可能是一个接受人群，因为他们对癌症的风险有更高和更突出的意识。公共卫生和患者干预策略必须了解：1)适应亲属诊断的复杂过程；2)可能有特定需求的人群的特征变量。虽然这些问题已经在乳腺癌患者的亲属中进行了一定程度的研究，但重要的问题仍然存在，包括随着时间的推移，哪些因素影响并与感知到的风险和情绪困扰相互作用，应对方式和健康行为在适应过程中的作用。众所周知，亲属之间的风险感知和情绪困扰差异很大，但不同亚群内的问题尚未表征。缺乏这些问题的信息部分是由于横断面设计的固有局限性。我们对大约422名乳腺癌“指数”患者的520名一级女性亲属的适应过程进行了前瞻性、纵向调查。我们将追求以下具体目标：在癌症患者亲属中：1)评估与感知风险相关的态度，知识，情绪困扰和应对；2)确定参与筛查的自然病史和12个月内生活方式行为的改变；3)进行广泛的、理论驱动的多因素分析，建立信念和行为如何随着时间的推移而受到影响的模型。在乳腺癌患者中：1)评估患者的总体痛苦程度、对乳腺癌的认识/认知以及对亲属的建议；2)探讨患者报告与其亲属信念和调整的关系。患者将在初步诊断后的六周内进行接触和面谈。他们的亲属将在基线（T0）、6个月（T1）和12个月（T2）随访时进行电话访谈。本研究的结构选择自社会信息加工和个体差异的社会认知表述，特别是米勒的C-SHIP模型。大多数度量都是标准化的工具，具有一定的有效性和可靠性。数据分析将侧重于假设路径的多变量建模，使用随时间推移的面板设计，以及样本中临床意义亚组的模式表征。

Targeting messages to people at higher risk of cancer or with increased receptivity can enhance the efficiency and effectiveness of prevention and early detection efforts. Relatives of cancer patients near the time of diagnosis may be a receptive population due to a higher and more salient sense of their cancer risk. Public health and patient intervention strategies must be informed by understanding: 1) the complex process of adaptation to a relative's diagnosis; and 2) the variables that characterize subgroups of the population who may have specific needs. While these issues have been studied to some extent in relatives of breast cancer patients, important questions remain, including what factors influence and interact with perceived risk and emotional distress over time, the role of coping style and health behavior in the adaption process. It is known that risk perception and emotional distress vary widely among relatives, but the issues within distinct subgroups have not been characterized. The lack of information on these questions is partly due to the inherent limitations of cross- sectional designs. We propose a prospective, longitudinal investigation of the process of adaptation in a 520 first-degree female relatives of approximately 422 breast cancer "index" patients. We will pursue the following specific aims: Among relatives of cancer patients to: 1) Assess attitudes, knowledge, emotional distress, and coping, in relation to perceived risk; 2) Determine the natural history of screening participation and lifestyle behavior change over 12 months; 3) Engage in an extensive, theory-driven multi-factorial analysis to build models of how beliefs and behaviors are influenced over time. Among breast cancer patients, to: 1) Assess the patient's general level of distress, knowledge/perceptions about breast cancer, and advice given to relatives; and 2) Explore the relationship of the patient's report to their relatives' beliefs and adjustment. Patients will be contacted and interviewed in person within six weeks of their initial diagnosis. Their relatives will be interviewed by telephone at baseline (T0), and at 6-month (T1) and 12-month (T2) follow-ups. Constructs for the study have been selected from social cognitive formulations of social information processing and individual difference, specifically Miller's C-SHIP model. A majority of measures are standardized tools with respected validity and reliability. Data analysis will focus on the multi-variate modeling of the hypothesized paths, using a panel design over time, as well as on the characterization of patterns within clinically meaningful subgroups of the sample.