Couples and Cancer: Building Partner Efficacy in Caring

DESCRIPTION (provided by applicant): This proposal is to develop and evaluate a multimedia program to instruct lay caregivers in safe and informed use of massage as a form of support in cancer. Phase I focus groups identified common concerns about use of touch as support in cancer. We then delivered instruction using a workshop format. Feasibility was demonstrated by significant and sustained increases in use of massage, self-efficacy, satisfaction, and qualitative data from focus groups. In Phase II we will develop a DVD with manual (each in English and Spanish) to deliver the instruction, and evaluate its effects in a randomized controlled trial. The final product will be a multimedia program for use by the mass audience of family members and other lay care providers for cancer patients. Specific Aims: 1. Produce a multimedia program to deliver instructional content in massage for lay care partners and cancer patients. 2. Determine the effects of the multimedia program on caregiver esteem and stress and on the frequency and duration of the care partner's provision of their assigned form of support to the patient. 3. Determine the effects of the multimedia program on patient symptom levels, functional quality of life, perceived stress, and physiologic indices of stress. Hypotheses: 1. Partners in the massage condition will show greater gains in caregiver esteem and reductions in perceived stress; and they will provide their assigned form of support with greater frequency and duration than will partners in the quality time condition. 2. Patients in the massage condition will have greater improvements in symptom levels, functional quality of life, and perceived stress than will patients in the quality time condition. 3. Patients in the massage condition will have reduced morning rise at 30 min post awakening in salivary cortisol relative to controls and an enhanced diurnal decline from waking to evening sample. Salivary DHEA will be increased overall in patients receiving the massage intervention. Secondary aim: Examine the impact of the multimedia program on care partner concerns about use of touch as a form of support, and on self-efficacy in massage. Secondary hypothesis: Partners assigned to the massage condition will experience greater reduction in levels of concern about touch and increase in self- efficacy in using touch as support over time. Method: Randomized controlled trial with 100 patient/caregiver dyads, over a 6-month period. Subjects will use standardized self- report measures and investigator-generated measures. Patients will use a new non- invasive approach to saliva collection for physiological data. Relevance to public health: Home-based caregiving in cancer is a rapidly expanding societal phenomenon. Simple massage techniques have been shown to bring significant relief from suffering in cancer, but lay caregivers are reluctant to use touch for fear of causing harm. The proposed educational product will promote wide societal acceptance of safe and informed use of touch as palliative care in cancer by family members and other lay caregivers. This project will develop an instructional multimedia program to promote wide societal acceptance and normalization of the safe and informed use of touch as a form of support by family members and other lay caregivers for people with cancer. If successful the program will contribute to enhanced caregiver self-efficacy, reduced suffering by patients, and reduced costs associated with amelioration of symptoms and side effects of treatment.