Couples and Cancer: Building Partner Efficacy in Caring

描述(由申请人提供)：这项建议是开发和评估一个多媒体计划，以指导业馀照顾者安全和知情地使用按摩作为癌症支持的一种形式。第一阶段的焦点小组确定了对使用触摸作为癌症支持的共同担忧。然后，我们以研讨会的形式进行授课。来自焦点小组的按摩使用、自我效能、满意度和定性数据的显著和持续增长证明了可行性。在第二阶段，我们将开发一张DVD和手册(分别有英语和西班牙语)来传递说明，并在随机对照试验中评估其效果。最终的产品将是一个多媒体节目，供广大家庭成员和其他癌症患者非专业护理提供者使用。具体目标：1.制作多媒体节目，为业馀护理伙伴和癌症患者提供按摩教学内容。2.确定多媒体项目对照顾者的尊重和压力的影响，以及对护理伙伴向患者提供指定形式支持的频率和持续时间的影响。3.确定多媒体程序对患者症状水平、功能生活质量、感知压力和应激生理指标的影响。假设：1.按摩状态下的伴侣将在照顾者自尊方面表现出更大的收益，并减少感知到的压力；与优质时间条件下的伴侣相比，他们将以更高的频率和更长的持续时间为他们提供指定形式的支持。2.处于按摩状态的患者在症状水平、功能生活质量和感受到的压力方面将比处于优质时间状态的患者有更大的改善。3.与对照组相比，接受按摩治疗的患者在醒后30分钟唾液皮质醇的晨升减少，从清醒到傍晚的日降幅增加。在接受按摩干预的患者中，唾液DHEA总体上将增加。第二目标：研究多媒体项目对护理伙伴对使用触摸作为一种支持形式的担忧的影响，以及对按摩自我效能的影响。第二假设：随着时间的推移，被分配到按摩条件下的伴侣对触摸的担忧程度将会大大降低，而使用触摸作为支持的自我效能感将会增加。方法：随机对照试验，100名患者/照顾者，为期6个月。受试者将使用标准化的自我报告测量方法和调查人员生成的测量方法。患者将使用一种新的非侵入性方法来收集唾液的生理数据。与公共卫生相关：癌症的居家护理是一种迅速扩大的社会现象。简单的按摩技巧已被证明能显著缓解癌症的痛苦，但非专业护理人员不愿使用触摸，因为担心造成伤害。拟议的教育产品将促进社会广泛接受家庭成员和其他业外照顾者将触摸作为癌症姑息治疗的安全和知情的使用。该项目将开发一个教学多媒体程序，以促进家庭成员和其他非专业照顾者对癌症患者的安全和知情使用触摸作为一种支持形式的广泛社会接受和常态化。如果成功，该计划将有助于提高照顾者的自我效能，减少患者的痛苦，并降低与改善症状和治疗副作用相关的成本。

DESCRIPTION (provided by applicant): This proposal is to develop and evaluate a multimedia program to instruct lay caregivers in safe and informed use of massage as a form of support in cancer. Phase I focus groups identified common concerns about use of touch as support in cancer. We then delivered instruction using a workshop format. Feasibility was demonstrated by significant and sustained increases in use of massage, self-efficacy, satisfaction, and qualitative data from focus groups. In Phase II we will develop a DVD with manual (each in English and Spanish) to deliver the instruction, and evaluate its effects in a randomized controlled trial. The final product will be a multimedia program for use by the mass audience of family members and other lay care providers for cancer patients. Specific Aims: 1. Produce a multimedia program to deliver instructional content in massage for lay care partners and cancer patients. 2. Determine the effects of the multimedia program on caregiver esteem and stress and on the frequency and duration of the care partner's provision of their assigned form of support to the patient. 3. Determine the effects of the multimedia program on patient symptom levels, functional quality of life, perceived stress, and physiologic indices of stress. Hypotheses: 1. Partners in the massage condition will show greater gains in caregiver esteem and reductions in perceived stress; and they will provide their assigned form of support with greater frequency and duration than will partners in the quality time condition. 2. Patients in the massage condition will have greater improvements in symptom levels, functional quality of life, and perceived stress than will patients in the quality time condition. 3. Patients in the massage condition will have reduced morning rise at 30 min post awakening in salivary cortisol relative to controls and an enhanced diurnal decline from waking to evening sample. Salivary DHEA will be increased overall in patients receiving the massage intervention. Secondary aim: Examine the impact of the multimedia program on care partner concerns about use of touch as a form of support, and on self-efficacy in massage. Secondary hypothesis: Partners assigned to the massage condition will experience greater reduction in levels of concern about touch and increase in self- efficacy in using touch as support over time. Method: Randomized controlled trial with 100 patient/caregiver dyads, over a 6-month period. Subjects will use standardized self- report measures and investigator-generated measures. Patients will use a new non- invasive approach to saliva collection for physiological data. Relevance to public health: Home-based caregiving in cancer is a rapidly expanding societal phenomenon. Simple massage techniques have been shown to bring significant relief from suffering in cancer, but lay caregivers are reluctant to use touch for fear of causing harm. The proposed educational product will promote wide societal acceptance of safe and informed use of touch as palliative care in cancer by family members and other lay caregivers. This project will develop an instructional multimedia program to promote wide societal acceptance and normalization of the safe and informed use of touch as a form of support by family members and other lay caregivers for people with cancer. If successful the program will contribute to enhanced caregiver self-efficacy, reduced suffering by patients, and reduced costs associated with amelioration of symptoms and side effects of treatment.