Self-Determination Theory and Lifestyle Behaviors in Barrett's Esophagus Patients

描述(申请人提供)：巴雷特食道(BE)在美国非常流行，它是由慢性胃食道反流病(GERD)引起的，是食管腺癌(EAC)发展的主要危险因素。肥胖和生活方式因素可能相互作用，调节个体对BE发展为EAC的易感性。事实上，生活方式咨询达到健康的体重，从事体育活动，戒烟，戒酒是新诊断的BE患者的护理标准。不遵守这些医疗建议的成本可能会很高，因为结果可能是生活质量(QOL)变差，食道切除的风险增加，甚至可能是癌症。令人惊讶的是，没有研究前瞻性地检查BE患者的生活质量，或者患者在确诊后是否做出并保持必要的生活方式改变。 自我决定理论(SDT)认为人们需要自主(选择)、能力(自我效能感)和与他人的关系。自主动机(即，行为与一个人的价值观一致)有助于行为的改变，而受控动机(即，为避免内疚或因为外部因素的要求而行为)则破坏行为改变。受控的动机通常发生在疾病诊断之后，随着时间的推移，可能会导致患者恢复到不适应的健康习惯。重要的其他人可以通过提供自主支持(例如，承认观点、提供选择)来积极影响患者改变生活方式行为的动机。虽然在一些研究中评估了家庭支持的一般作用，但很少特别关注配偶支持的作用。此外，尽管在慢性病和健康促进文献中存在许多基于SDT原则的成功干预措施，但研究人员尚未前瞻性地证明SDT结构在癌症预防方面的有效性。 具体目标是： 1.前瞻性地描述BE患者从基线(患者首次内窥镜检查前)到6个月后的生活方式行为(例如，饮食、体力活动、吸烟、饮酒)；并评估在同一时间段内患者生活方式行为变化的自我决定理论过程模型。 2.确定基线时的配偶自主支持(配偶沟通和关系质量)对BE患者在基线、3个月和6个月后进行推荐的生活方式改变(即，吃更健康的饮食、参加更多PA、达到健康的体重、停止吸烟和饮酒)的自主动机和感知能力的影响。 了解可能与BE患者生活方式改变相关的心理社会因素是未来针对这一人群的干预措施发展的重要但尚未实现的第一步。因此，拟议的项目涉及的投资相对较少，可以在了解这一未被研究的人群的健康促进需求方面取得很大进展。

DESCRIPTION (provided by applicant): Highly prevalent in the U.S., Barrett's Esophagus (BE) results from chronic gastroesophageal reflux disease (GERD) and is a major risk factor for the development of esophageal adenocarcinoma (EAC). Obesity and lifestyle factors may interact to modulate individual susceptibility for the progression of BE to EAC. In fact, lifestyle counseling to achieve a healthy body weight, engage in physical activity, stop smoking, and refrain from drinking alcohol is the standard of care for newly diagnosed BE patients. The cost of non-adherence to these medical recommendations is likely to be high, as the result may be poorer quality of life (QOL), increased risk of esophageal resection, and possibly cancer. Surprisingly, no studies have prospectively examined the QOL of BE patients or whether patients make and maintain needed lifestyle changes after diagnosis. Self-determination theory (SDT) posits that people have needs for autonomy (choice), competence (self- efficacy), and relatedness to others. Autonomous motivation (i.e., behaving congruently with one's values) facilitates behavior change; controlled motivation (i.e., behaving to avoid guilt or because of a demand from an external agent) undermines it. Controlled motives often follow an illness diagnosis and can result in patients reverting to maladaptive health habits over time. Important others can positively influence patients' motivation for lifestyle behavior change by providing autonomy support (e.g., acknowledging perspectives, providing choice). Although the general role of family support has been evaluated in a few studies, little attention has been paid specifically to the role of spousal support. In addition, even though numerous successful interventions based on SDT principles exist in the chronic illness and health promotion literatures, researchers have yet to prospectively demonstrate the efficacy of SDT constructs in the context of cancer prevention. The Specific aims are: 1. To prospectively characterize the lifestyle behaviors (e.g., diet, physical activity [PA], smoking, alcohol use) of BE patients from baseline (prior to the patient's first endoscopy) to 6 months later; and, to evaluate a Self-Determination Theory process model for patient lifestyle behavior change during the same time frame. 2. To determine the effects of spousal autonomy support (spousal communication and relationship quality) at baseline on BE patients' autonomous motivation and perceived competence to engage in recommended lifestyle changes (i.e., to eat a healthier diet, engage in more PA, achieve a healthy body weight, and stop smoking and drinking alcohol) at baseline and 3 and 6 months later. Understanding the psychosocial factors that may be associated with lifestyle changes among BE patients is an important and as yet unrealized first step toward the development of future interventions targeting this population. Thus, the proposed project involves a relatively small investment that could yield great progress in understanding the health promotion needs of this understudied population.