Positive Activities for Asian American Cancer Patients and Caregivers

点击翻译按钮获取中文摘要

PROJECT SUMMARY/ABSTRACT Asian Americans (AAs) are the fastest growing minority group in the U.S., and cancer is the leading cause of death among this group. Although AA who are diagnosed with cancer commonly report fear, distress, and depression, they have been found to utilize mental health services at lower rates than other groups and this may be due to a dearth of culturally-competent services. Prior research on these cancer patients’ lives has focused on barriers associated with health literacy and language proficiency but has ignored unique culture- related challenges that contribute to their poor emotional outcomes. AAs are members of collectivist cultures who view themselves as connected, relational, and belonging to a larger social group. Following changes in physical function and social roles and responsibilities (e.g., job loss) after a cancer diagnosis, individuals may self-perceive that they are a burden on their family members/caregivers. Therefore, the overarching goal of the current proposal is to reduce the burden AA patients may feel they are on their caregivers by designing and testing the feasibility of two positive activity interventions. We expect that contributing to one’s household and outside one’s home will increase health-related quality of life (HRQOL) in AA cancer patients by increasing a sense of relatedness, autonomy, and competence (mediators). In the K99 phase, 30 AAs ages 25-70 and within 1 year of any cancer diagnosis will engage in either: 1) household contribution; 2) outside contribution; or 3) control activities. Quantitative and qualitative (e.g., semi-structured interview, project personnel work logs) data about the successful elements of the interventions will be collected. In collaboration with the mentorship team, AA community members, and clinicians, a prototype of one or both positive activity interventions (household or outside contribution) will be developed for AA cancer patients. In the R00 phase, 118 patients (same inclusion criteria as K99 phase) will be randomized to either the contribution or control group. They will engage in the positive or control activity once per week for 3 months, and outcomes and mediators will be assessed at baseline, 1.5 months (midpoint), 3 months (post-test), and 6 months (follow-up). The trial will: 1) assess the feasibility and acceptability of the household and outside contribution positive activities, 2) develop a prototype of a positive activity intervention (household or outside contribution) for AA cancer patients, 3) assess changes in HRQOL comparing intervention to control patients, and 4) assess mediators of the intervention effects. This proposal introduces a novel, low cost, not stigmatizing, easy to implement, and highly scalable approach not previously tested in AA cancer patients: engaging in positive activities. If found to be successful, this framework for understanding patient-caregiver relationships in AAs can be used to develop other positive activities that will improve and extend the lives of cancer patients from other collectivist cultures. The proposed training plan will be critical in expediting the candidate’s transition into an independent investigator with focused expertise in developing positive activities to eliminate cancer care disparities in AAs.