Couples and Cancer: Building Partner Efficacy in Caring

描述（由申请人提供）：本提案旨在开发和评估一个多媒体程序，指导非专业护理人员安全、知情地使用按摩作为癌症治疗的一种支持形式。第一阶段的焦点小组确定了在癌症治疗中使用触摸作为支持的常见问题。然后，我们使用研讨会的形式提供指导。可行性通过按摩使用、自我效能、满意度和焦点小组的定性数据的显著和持续的增加来证明。在第二阶段，我们将制作一份带有手册的DVD（英语和西班牙语）来提供指导，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程序，供癌症患者的家庭成员和其他非专业护理人员使用。具体目标：1；制作一个多媒体节目，为护理伙伴和癌症患者提供按摩教学内容。2. 确定多媒体程序对护理人员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的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、功能性生活质量、感知压力和压力生理指标的影响。假设:1。在按摩条件下的伴侣会表现出更大的照顾者尊重和减少感知压力；他们会比在高质量时间条件下的合作伙伴更频繁和持续地提供指定形式的支持。2. 按摩条件下的患者在症状水平、功能生活质量和感知压力方面比质量时间条件下的患者有更大的改善。3. 与对照组相比，按摩组患者在醒来后30分钟的唾液皮质醇水平在早晨上升时有所减少，而从醒来到晚上的日下降幅度有所增强。在接受按摩干预的患者中，唾液脱氢表雄酮的总体水平会增加。次要目的：检查多媒体程序对护理伙伴对使用触摸作为一种支持形式的关注的影响，以及按摩的自我效能。次要假设：被分配到按摩条件下的伴侣随着时间的推移，对触摸的关注程度会大大降低，而使用触摸作为支持的自我效能会增加。方法：随机对照试验100名患者/护理者，为期6个月。受试者将使用标准化的自我报告方法和研究者生成的方法。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。与公共卫生的相关性：以家庭为基础的癌症护理是一个迅速扩大的社会现象。简单的按摩技术已被证明能显著缓解癌症的痛苦，但外行护理人员不愿使用触摸，因为害怕造成伤害。拟议的教育产品将促进家庭成员和其他非专业护理人员对安全、知情地使用触摸作为癌症姑息治疗的广泛社会接受。该项目将开发一个多媒体教学项目，以促进社会广泛接受和规范安全、知情地使用触摸，作为家庭成员和其他护理人员对癌症患者的一种支持形式。如果成功，该项目将有助于提高护理人员的自我效能，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.