Dyadic Analysis of Unmet Social Needs Among Breast and Gynecologic Patients and Their Informal Caregivers

乳腺和妇科患者及其非正式护理人员未满足的社会需求的二元分析

• 批准号: 10587457
• 负责人: Tess Thompson
• 金额: $ 2.73万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-19 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10587457
• 关键词: Academy; Address; Adherence; Affect; Anxiety; Area; Breast; Cancer Patient; Caregivers; Caring; Censuses; Characteristics; Communities; Diagnosis; Distress; Education; Emergency department visit; Emotional; Family member; Female; Food; Friends; Geography; Goals; Gynecologic; Health; Health system; Housing; Income; Individual; Intervention; Interview; Link; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Measures; Mental Health; Modeling; Neighborhoods; Newly Diagnosed; Outcome; Participant; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Population; Poverty; Quality of Care; Quality of life; Race; Reduce health disparities; Reporting; Research; Resources; Self Management; Social Conditions; Social Environment; Socioeconomic Status; Structure; System; Testing; Time; Transportation; United States; Woman; Work; biopsychosocial; cancer diagnosis; care outcomes; depressive symptoms; deprivation; experience; food insecurity; health disparity; improved; improved outcome; indexing; individual patient; informal caregiver; informal caregiving; interest; malignant breast neoplasm; member; men; mortality; physical conditioning; preference; primary outcome; psychological distress; residence; screening; secondary outcome; social; social health determinants; social vulnerability; socioeconomic disadvantage; treatment adherence; visit adherence

PROJECT SUMMARY/ABSTRACT Psychological distress is prevalent in cancer patients and their informal caregivers (the intimate partners, other family members, and friends who provide patients with crucial unpaid care and support). Distress has been linked to poorer adherence to treatment and elevated mortality in patients, as well as negative outcomes for caregivers. Whether patients or caregivers, women tend to report greater distress than men. Research on patient-caregiver dyads has shown patients' and caregivers' physical and mental health is often intertwined, but most prior dyadic work has analyzed predominantly middle-class spousal pairs. Given the persistent effects of poverty and the longstanding health disparities by socioeconomic status in the United States, it is crucial to understand the social context of financially vulnerable cancer patients and caregivers. Individual social needs—including food, housing, or transportation—are associated with distress as well as physical health outcomes in a range of contexts and populations. A growing body of research has analyzed single social needs—most commonly food insecurity—among cancer patients in particular, but little is known about multiple social needs in patients, how needs change over time, and whether the social needs of informal caregivers affect patient outcomes. This study focuses on female patients with breast and gynecologic cancer—which together account for over 400,000 newly diagnosed cancers among women annually—and their informal caregivers. Our aims are: Aim 1. Document unmet social needs in patient-caregiver dyads (N = 300 dyads). Analyze how needs affect patient and caregiver biopsychosocial outcomes including depressive symptoms (primary outcome), physical and mental health quality of life, emergency department (E.D.) visits, and treatment adherence (secondary outcomes). Aim 2. Analyze the experiences of patients and caregivers with unmet social needs and explore their interest in and preferences for mental health and social needs intervention. Use semi-structured dyadic interviews with 30 patient-caregiver pairs (N = 60 total participants) in which one member reports at least one unmet need at baseline to explore participants' use of community resources, whether they coordinate with the other member of the dyad to resolve unmet social needs, and their preferences for screening and intervention. Aim 3. Explore the relationship between neighborhood-level factors (census tract Area Deprivation Index and 2-1-1 helpline requests by ZIP code), social needs, and depressive symptoms within dyads. This study will provide first-of-its-kind information about the biopsychosocial effects of unmet social needs among female patients with cancer and their caregivers. A central question is whether and how caregivers' social needs affect the patient. The answer will help us create a targeted screening and intervention system to address the mental health and social needs of patients, and, if warranted, caregivers. Our ultimate goal is to improve outcomes for women with cancer and their caregivers.

项目总结/摘要 心理困扰在癌症患者及其非正式照顾者（亲密伴侣，其他 家庭成员和为患者提供重要的无偿护理和支持的朋友）。不幸的是 与患者对治疗的依从性较差和死亡率升高有关， 照顾者无论是病人还是照顾者，女性往往比男性报告更大的痛苦。研究 患者-护理者二人组显示患者和护理者的身体和精神健康通常是交织在一起的， 但大多数之前的二元工作主要分析了中产阶级配偶对。考虑到持续的影响 贫困和长期存在的健康差距的社会经济地位在美国，这是至关重要的， 了解经济上脆弱的癌症患者和照顾者的社会背景。个人社会 需求--包括食物、住房或交通--与痛苦和身体健康有关 在一系列背景和人群中取得成果。越来越多的研究分析了单一的社会 特别是癌症患者的需求-最常见的是食物不安全，但对多种疾病知之甚少。 患者的社会需求，需求如何随时间变化，以及非正式护理人员的社会需求是否 影响患者的预后。这项研究的重点是女性乳腺癌和妇科癌症患者， 每年有超过40万名女性新诊断出癌症， 照顾者我们的目标是：目标1。记录患者-护理人员二人组中未满足的社会需求（N = 300二人组）。 分析需求如何影响患者和护理人员的生物心理社会结果，包括抑郁症状 （主要结局），身心健康生活质量，急诊科（E. D.）的参观以及 治疗依从性（次要结局）。目标二。分析患者和护理人员的经验， 未满足的社会需求，并探索他们对心理健康和社会需求的兴趣和偏好 干预使用半结构化的二元访谈与30对患者-护理人员（N = 60名参与者）， 其中一名成员在基线时报告至少一个未满足的需求，以探索参与者使用社区 资源，他们是否与其他成员协调，以解决未满足的社会需求，以及他们的 筛选和干预的偏好。目标3.探讨邻里关系的层次 因素（人口普查区区域发展指数和按邮政编码划分的2-1-1电话请求）、社会需求，以及 抑郁症的症状。这项研究将提供有关 未满足的社会需求对女性癌症患者及其照顾者的生物心理社会影响。一 中心问题是照顾者的社会需求是否以及如何影响病人。答案将帮助我们创造 有针对性的筛查和干预系统，以满足患者的精神健康和社会需求，如果 有保证的，照顾者。我们的最终目标是改善癌症妇女及其护理人员的结果。