Psychoeducation for BMT caregivers: Biobehavioral markers and outcome

描述（由申请人提供）：本次重新提交是对PA-07-046“身心相互作用与健康研究”的回应。“国家癌症研究所特别关注癌症生存率，其中护理人员被视为患者康复过程的一个组成部分。2000年，美国有超过590万名成年照顾者，影响到超过2240万个家庭。虽然护理人员可以减少患者的医疗护理费用，但对护理人员的影响是巨大的，导致失去工作，经济负担，以及增加的医疗和心理健康问题。有大量的文献介绍了运动对心理健康、免疫调节和神经内分泌平衡的影响。这些基本的自我平衡过程的紊乱对照顾者的健康有长期的影响。接受同种异体血液和骨髓移植（BMT）的患者的护理人员面临着以不确定性和患者中医源性疾病的可能性为特征的紧张经历，所述医源性疾病例如与BMT相关的移植物抗宿主病。批准同种异体BMT需要24小时护理人员在场至少100天，通常更长。尽管许多干预措施针对癌症患者，但很少有关注照顾者癌症患者的干预措施，更少的是遵循与这些干预措施相关的生物标志物。压力管理和心理教育已被证明是有用的，当因变量包括行为标记。然而，许多干预研究使用了方便的样本，未能随机化治疗，没有包括对照组进行比较，或省略了生物标志物。本研究提出了一项随机对照试验，目的是治疗BMT患者的护理人员，他们被分配到常规治疗或个性化的压力管理心理教育，包括生物反馈装置，用于训练节奏呼吸，同时跟踪依从性。依赖性测量包括护理人员和患者的健康，免疫和内分泌标志物，通过活动测定的睡眠特征，以及压力，抑郁，焦虑和负担的行为评估。与常规治疗相比，这种独特的压力管理心理教育干预预计将对护理人员身心健康的生物标志物产生积极影响，包括睡眠，免疫标志物（天然细胞毒性和1型和2型细胞因子平衡）和内分泌标志物（唾液皮质醇和DHEA的昼夜变化）。这种干预措施的重点是由卫生局局长的处方提出的照顾者的需要，在基本层面上，1）解决抑郁和焦虑的问题，2）确定社区内的支持来源，照顾者，3）侧重于照顾者自己的健康在他们照顾病人的作用，4）提高照顾者对他们的压力及其对他们的影响，5）教导照顾者关于他们所爱的人正在经历的疾病，以及6）提供压力管理工具。公共卫生救济。 在一个每四个美国家庭中就有三个至少有一个成员被诊断出患有癌症的国家，根据国家癌症研究所（NCI）的说法，“生存”包括患者和支持他们的人。护理人员是一个痛苦的群体，已成为NCI和外科医生办公室的重点。血液和骨髓移植（BMT）患者的护理人员是一个特别痛苦的群体，因为他们在移植后的前100天需要24/7的护理。本研究将采用随机对照设计，测试压力管理心理教育计划与常规治疗对BMT照顾者身心健康的影响，因为照顾者的健康对BMT患者的长期预后也至关重要。

DESCRIPTION (provided by applicant): This resubmission is in response to PA-07-046, "Research on mind body interactions and health." The National Cancer Institute is particularly concerned about cancer survivorship in which the caregiver is viewed as an integral component of the patient's recovery process. The number of adult caregivers exceeded 5.9 million in 2000, affecting over 22.4 million households in the US. Although caregivers may reduce medical care costs of the patient, the impact on the caregiver is substantial leading to lost work, financial burden, and increased medical and mental health problems. There is an extensive literature on the impact of caregiving on psychological well being, immune regulation, and neuroendocrine balance. Perturbations in these basic homeostatic processes have long term health consequences for the caregivers. Caregivers of patients receiving allogeneic blood and marrow transplants (BMT) are faced with a stressful experience marked by uncertainly and the likelihood of iatrogenic illness in the patient such as graft versus host disease associated with BMT. Approval for an allogeneic BMT requires the presence of a 24 hour caregiver for at least 100 days and quite often longer. Although a number of interventions have targeted the cancer patient, there have been few that have focused on the caregiver cancer patients and even fewer that have followed biomarkers in association with these interventions. Stress management and psychoeducation has been demonstrated as useful when dependent variables include behavioral markers. However many intervention studies have used convenience samples, failed to randomize treatments, did not include control groups for comparison purposes, or omitted biomarkers. The present study proposes a randomized control trial with intent to treat of BMT patient caregivers assigned to either treatment as usual or individualized stress management psychoeducation that includes a biofeedback device for training paced respiration which also tracks compliance. Dependent measures include caregiver and patient health, immune and endocrine markers, sleep characteristics via actimetry, and behavioral assessments of stress, depression, anxiety, and burden. This unique stress management psychoeducation intervention is expected to have positive effects on biomarkers of caregiver physical and psychological health including sleep, immune markers (natural cytotoxicity and Type 1 and 2 cytokine balance), and endocrine markers (diurnal variations in salivary cortisol and DHEA) compared to treatment as usual. This intervention focuses on needs of caregivers raised by the Surgeon General's Rx for caregivers at fundamental levels by 1) addressing issues around depression and anxiety, 2) identifying sources of support within the community for the caregivers, 3) focusing on the role of the caregiver's own health in their care of the patient, 4) sensitizing the caregivers to their stress and its effects on them, 5) teaching the caregiver about the illness their loved one is experiencing, and 6) providing stress management tools. PUBLIC HEALTH RELEVENCE. In a nation where three out of every four American families will have at least one member diagnosed with cancer, "survivorship" according to the National Cancer Institute (NCI) includes both the patient and those who support them. Caregivers are a distressed group which has become the focus of the NCI as well as the Office of the Surgeon General. Caregivers of blood and marrow transplant (BMT) patients are a particularly distressed group since their care is required 24/7 for the first 100 days following transplantation. The present study will test using a randomized control design, the impact of a stress management psychoeducation program versus treatment as usual on the physical and mental health of BMT caregivers since caregiver health is crucial to the long term prognosis in BMT patients as well.