Biological and Psychosocial Mechanisms of Cancer Caregivers' Elevated Health Risk

癌症护理人员健康风险升高的生物和心理社会机制

• 批准号: 9357708
• 负责人: YOUNGMEE KIM
• 金额: $ 49.32万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-26 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9357708
• 关键词: Address; Affect; Affective; Arousal; Biological; Biological Markers; Cancer Patient; Cancer Survivor; Cardiovascular system; Caregivers; Chronic Disease; Development; Disease; Distress; Family Caregiver; Family member; Female; Gender; Health; Health Care Visit; Health Promotion; Heterosexuals; Hydrocortisone; Immune system; Influentials; Intervention; Investigation; Life; Link; Malignant Neoplasms; Modeling; Moods; Morbidity - disease rate; Neurosecretory Systems; Outcome; Outcome Measure; Pathway interactions; Patient Self-Report; Patients; Pattern; Persons; Physiological; Population; Preparation; Process; Public Health; Recovery; Regulation; Research; Rest; Resting Phase; Risk; Role; Salivary; Self Management; Sleep; Sleep disturbances; Speech; Standardization; Stress; Testing; Touch sensation; Translating; Woman; biological adaptation to stress; colon cancer patients; depressive symptoms; heart rate variability; high risk; improved; male; member; mortality; multilevel analysis; negative affect; negative mood; novel; premature; prospective; psychological distress; psychosocial; response; stress management; stress reactivity; stressor

Project Summary/Abstract Cancer affects not only those with the disease, but also their family members. Family caregivers are known to have compromised health, as the detrimental impact of patients' cancer on their caregivers is substantial. Studies have documented the patient's distress relates to the caregiver's poorer health and vice versa, suggesting that cancer caregivers' health is an interpersonal, dyadic problem. Unknown are when and how the dyadic, cross-over effects occur. Stress regulation among cancer caregivers and their patients is interdependent, as is the caregiver-patient relationship itself. This dyadic stress regulation occurs when members of a dyad mutually calm each other's stress reactions and dampen negative affect and physiological arousal (coregulation) or mutually increasing those outcomes (coagitation). We propose that greater stress coregulation protects against adverse health outcomes, whereas greater stress coagitation exacerbates them. This project will examine dyadic stress regulation between cancer caregivers and their patients, and test coregulation and coagitation as predictors of health outcomes. Coregulation/coagitation will be quantified by cardiovascular (heart rate variability: HRV), neuroendocrine (salivary cortisol), and self-reported affective reactivity and regulation, in response to a standardized stress situation that is relevant both to health and to close relationships. We will then examine prospectively the extent to which the indicators of coregulation for this discrete stressor relate to daily outcomes (mood, diurnal cortisol, and sleep) and interim health outcomes (depressive symptoms, resting HRV, and healthcare visits), and the degree to which gender moderates such effects. A total of 120 colorectal cancer (CRC) patients (60 male and 60 female) and their heterosexual caregiver (120 dyads) will participate. Understanding underlying biological and psycholgoical mechanisms is critical for identifying cancer caregivers and their patients who are at most risk for poor health due to their mutual stress regulation patterns. Findings of this project will be readily translated to development of novel interventions pertaining to effective and mutual management of stress in daily life and dyadic influences on health promotion. Those interventions will aim helping one another to better modulate and manage stress and optimizing beneficial effects of coregulation of cancer-related stress on better health. These tailored-and-targeted interventions will help caregivers identify when and how they should engage in stress self-management in the context of illness trajectory of their relative with cancer. They will also aim at reducing premature morbidity and mortality, particularly related to dysregulated cardiovascular, neuroendocrine, and immunologic systems, and psychological distress, among persons touched by cancer and other chronic illness, thereby improving public health.

项目概要/摘要 癌症不仅影响患者，还影响他们的家人。众所周知，家庭照顾者 损害了健康，因为患者的癌症对其护理人员的不利影响是巨大的。 研究表明，患者的痛苦与护理人员的健康状况不佳有关，反之亦然， 表明癌症护理人员的健康是一个人际关系的二元问题。未知何时以及如何 发生二元交叉效应。癌症护理人员及其患者的压力调节 相互依存，护理者与患者的关系本身也是如此。这种二元压力调节发生在 二人组成员相互平息彼此的压力反应并抑制负面情绪和生理 唤醒（共同调节）或相互增强这些结果（凝聚）。我们建议加大压力 共同调节可以防止不良的健康结果，而更大的压力聚合则会加剧不良的健康结果。 该项目将研究癌症护理人员与其患者之间的二元压力调节，并测试 共同调节和协同作为健康结果的预测因子。共调节/共凝将通过以下方式量化 心血管（心率变异性：HRV）、神经内分泌（唾液皮质醇）和自我报告的情感 反应和调节，以应对与健康和生活相关的标准化压力情况 密切的关系。然后，我们将前瞻性地考察共同监管指标在多大程度上 这种离散的压力源与日常结果（情绪、昼间皮质醇和睡眠）和中期健康结果有关 （抑郁症状、静息 HRV 和医疗就诊），以及性别对此类影响的程度 影响。总共 120 名结直肠癌 (CRC) 患者（60 名男性和 60 名女性）及其异性恋 护理人员（120 人）将参加。 了解潜在的生物学和心理机制对于识别癌症护理人员至关重要 以及由于相互压力调节模式而面临健康状况不佳风险最大的患者。发现 该项目的成果将很容易转化为开发有关有效和相互的新干预措施 日常生活压力管理和对健康促进的双重影响。这些干预措施的目的是 互相帮助，更好地调节和管理压力，优化共同调节的有益效果 癌症相关的压力对改善健康有帮助。这些量身定制和有针对性的干预措施将帮助护理人员识别 他们应该根据其亲属的疾病轨迹何时以及如何进行压力自我管理 患有癌症。他们还将致力于减少过早发病率和死亡率，特别是与 心血管、神经内分泌和免疫系统失调以及心理困扰等 患有癌症和其他慢性疾病的人，从而改善公共健康。