Psychoeducation for BMT caregivers: Biobehavioral markers and outcome

描述(申请人提供)：此重新提交是对PA-07-046，“关于身心互动和健康的研究”的回应。国家癌症研究所特别关注癌症的存活率，在这种情况下，照顾者被视为患者康复过程中不可或缺的组成部分。2000年，成年照顾者的数量超过590万人，影响到美国超过2240万个家庭。尽管照顾者可能会降低患者的医疗成本，但对照顾者的影响是巨大的，导致失业、经济负担以及增加医疗和心理健康问题。关于照顾对心理健康、免疫调节和神经内分泌平衡的影响，有大量的文献。这些基本的动态平衡过程中的扰动会对照顾者产生长期的健康后果。接受异基因血液和骨髓移植(BMT)的患者的照顾者面临着一种压力体验，其特点是患者存在不确定性和医源性疾病的可能性，如与BMT相关的移植物抗宿主病。异基因骨髓移植的批准需要24小时照顾者至少100天，甚至更长时间。尽管有许多针对癌症患者的干预措施，但很少有针对照顾者癌症患者的干预措施，更没有关注与这些干预措施相关的生物标记物的干预措施。当因变量包括行为标记物时，压力管理和心理教育已被证明是有用的。然而，许多干预研究使用了方便的样本，未能随机化处理，没有包括用于比较目的的对照组，或者省略了生物标记物。本研究提出了一项随机对照试验，意在对BMT患者照顾者进行治疗，这些照顾者被分配到常规治疗或个性化压力管理心理教育中，其中包括用于训练有节奏呼吸的生物反馈设备，该设备也跟踪依从性。依赖测量包括照顾者和患者的健康、免疫和内分泌标记物、通过运动测量获得的睡眠特征，以及对压力、抑郁、焦虑和负担的行为评估。这一独特的压力管理心理教育干预预计将对照顾者身心健康的生物标记物产生积极影响，包括睡眠、免疫标记物(自然细胞毒性和1型和2型细胞因子平衡)以及内分泌标记物(唾液皮质醇和脱氢表雄酮的日变化)。这种干预的重点是通过1)解决围绕抑郁和焦虑的问题，2)确定社区内对照顾者的支持来源，3)集中于照顾者自身健康在他们对病人的护理中的作用，4)使照顾者意识到他们的压力及其对他们的影响，5)向照顾者传授他们所爱的人正在经历的疾病，以及6)提供压力管理工具，从而在基本层面上满足照顾者对照顾者的需求。

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.