Spousal Relationships and Adjustment in Lung Cancer

描述（由申请人提供）： 肺癌患者的生存预后差，与其疾病和治疗相关的发病率高。肺癌可能对多个QOL领域产生不良影响，包括功能状态和心理健康。后者受到的关注较少，这是令人惊讶的，因为患者有很高的心理困扰风险，因为疾病的衰弱性质，除了烟草依赖外，可能还有药物滥用史，可能会因疾病原因而感到内疚或自责，以及可能有心理困扰的过去史。慢性病患者的配偶经常经历相同的痛苦，如果不是更高，比病人。高水平的患者和配偶的心理困扰可能会促进夫妻关系中的冲突。与面临非烟草相关癌症的夫妇相比，面临肺癌的夫妇的关系可能会增加痛苦的风险。如果患者、配偶或双方在诊断后继续吸烟，冲突可能会加剧。随着肺癌的进展，患者的需求水平可能会增加。配偶满足这些要求和提供支持的能力可能会受到挑战，在痛苦的关系。没有研究评估配偶对肺癌诊断和治疗的反应，配偶的反应如何影响患者的反应，或者夫妇的关系如何影响患者的调整，配偶的调整和照顾者的负担。 本研究将采用纵向设计，评估肺癌患者及其配偶的心理和关系功能。具体目标是：（1）确定肺癌患者、配偶和配偶关系随时间的患病率;（2）确定在患者、配偶或两者在诊断后吸烟的关系中，患病配偶关系的患病率是否更高;（3）描述患者和配偶心理功能预测因素之间的关联（应对、社会支持、烟草使用和归因）、患者心理功能、配偶心理功能、关系功能和诊断后6个月的照顾者负担;（4）确定诊断后3个月和6个月照顾者负担的基线预测因素。

DESCRIPTION (provided by applicant): Lung cancer patients have a poor survival prognosis and high levels of morbidity associated with their disease and treatment. Lung cancer can have an adverse effect on multiple QOL domains including functional status and psychological well-being. The latter has received less attention, which is surprising because patients are at high risk for psychological distress given the debilitating nature of the illness, a possible history of substance abuse in addition to tobacco dependence, the likelihood of experiencing guilt or self-blame because of their disease cause, and a possible past history of psychological distress. Spouses of chronically ill patients frequently experience equal, if not higher, levels of distress than patients. High levels of both patient and spouse psychological distress may promote conflict within the couple's relationship. Relationships of couples facing lung cancer may be at increased risk for distress as compared to couples facing non-tobacco-related cancers. Conflict may be exacerbated in couples in which the patient, spouse, or both continue to smoke following diagnosis. As lung cancer progresses, the level of caregiving demands may increase. The spouse's ability to meet these demands and offer support may be challenged in distressed relationships. No studies have assessed spouse response to lung cancer diagnosis and treatment, how spouse response affects that of the patient, or how the couple's relationship affect's the patient's adjustment, the spouse's adjustment and caregiver burden. This study will employ a longitudinal design to assess the psychological and relationship functioning of lung cancer patients and spouses. The specific aims are to: (1) determine the prevalence of distressed patients, spouses and spousal relationships in lung cancer over time; (2) determine whether the prevalence of distressed spousal relationships is higher in relationships where the patient, spouse, or both smoke following diagnosis; (3) characterize the associations among predictors of psychological functioning in both patients and spouses (coping, social support, tobacco use, and attribution), patient psychological functioning, spouse psychological functioning, relationship functioning, and caregiver burden from diagnosis to six months following diagnosis; and (4) determine baseline predictors of caregiver burden at three and six months following diagnosis.