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

描述（由申请人提供）：在美国高度流行，巴雷特食管（BE）由慢性胃食管反流病（GERD）引起，是食管腺癌（EAC）发展的主要风险因素。肥胖和生活方式因素可能相互作用，以调节BE进展为EAC的个体易感性。事实上，生活方式咨询，以实现健康的体重，从事体育活动，戒烟，并避免饮酒是新诊断的BE患者的护理标准。不遵守这些医疗建议的成本可能很高，因为结果可能是生活质量（QOL）较差，食管切除术的风险增加，并可能是癌症。令人惊讶的是，没有研究前瞻性地检查BE患者的生活质量或患者在诊断后是否做出并维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）和与他人的关系。自主动机（即，行为与一个人的价值观一致）促进行为改变;受控的动机（即，控制的动机往往伴随着疾病的诊断，随着时间的推移，可能导致病人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，提供选择，提供观点）。虽然在一些研究中对家庭支持的一般作用进行了评估，但很少有人专门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.为了前瞻性地描述生活方式行为（例如，从基线（患者首次内镜检查前）至6个月后BE患者的饮食、体力活动[PA]、吸烟、饮酒）;以及，评价同一时间范围内患者生活方式行为变化的自我决定理论过程模型。 2.确定基线时配偶自主支持（配偶沟通和关系质量）对BE患者自主动机和感知能力的影响，以进行建议的生活方式改变（即，吃更健康的饮食，参与更多的PA，达到健康的体重，停止吸烟和饮酒）。 了解可能与BE患者生活方式改变相关的心理社会因素是制定针对该人群的未来干预措施的重要且尚未实现的第一步。因此，拟议的项目涉及相对较小的投资，但在了解这一未得到充分研究的人口的健康促进需求方面可能会取得很大进展。

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.