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的研究”的回应。美国国家癌症研究所特别关注癌症幸存者，在这种情况下，护理人员被视为患者康复过程中不可或缺的组成部分。2000年，成人看护人数超过590万，影响到美国2240多万个家庭。虽然护理人员可以减少患者的医疗费用，但对护理人员的影响是实质性的，导致失业，经济负担，增加医疗和精神健康问题。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。这些基本的自我平衡过程的扰动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）患者的护理人员面临着一种以不确定性和患者医源性疾病（如与BMT相关的移植物抗宿主病）的可能性为特征的压力体验。同种异体BMT的批准需要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的是癌症患者，但很少有针对癌症患者护理者的干预措施，而跟踪与这些干预措施相关的生物标志物的干预措施则更少。当因变量包括行为标记时，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样本，未能随机化治疗，没有包括用于比较目的的对照组，或者省略了生物标志物。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，其中包括一个生物反馈装置，用于训练有节奏的呼吸，并跟踪依从性。依赖指标包括护理者和患者的健康状况、免疫和内分泌指标、通过活动测量获得的睡眠特征，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有望对护理者生理和心理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（唾液皮质醇和脱氢表雄酮的日变化）。这一干预措施的重点是根据《外科医生处方》对护理人员提出的基本需求：1)解决与抑郁和焦虑有关的问题，2)确定社区内对护理人员的支持来源，3)关注护理人员自身健康在护理患者中的作用，4)使护理人员敏感地认识到他们的压力及其对他们的影响，5)教护理人员了解他们所爱的人正在经历的疾病。6)提供压力管理工具。

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.