Where you begin is not necessarily where you end: the mental and physical health trajectories of cancer caregivers over time.

PURPOSE: Cancer caregiving, a critical component in the cancer-care model, has deleterious effects on the caregiver's physical and mental health. The degree to which these negative effects are uniformly experienced by caregivers is unclear; effects may be exacerbated at the end of life when caregiving is intensified. Not all caregivers have the support of an additional involved support person (secondary caregiver). The impact of the secondary caregiver's absence on the primary caregiver's well-being is understudied. METHODS: Terminal cancer patient-caregiver dyads (n = 223) were recruited from oncology clinics and followed for six months or until patient death. Longitudinal latent growth models were used to characterize the heterogeneity of caregiver physical health and depressive symptoms; characteristics associated with these trajectories are examined. RESULTS: Caregivers were majority female (74%), white (55%) and patient spouses (60%). Two physical health (moderate, stable; initially good, declining) and two depressive symptom (moderate, stable; high, increasing) trajectories were identified. Declining physical health was more likely among caregivers who were healthiest at baseline, had higher levels of education, lower subjective burden, fewer depressive symptoms, cared for patients with fewer functional limitations and reported fewer caregiving tasks rendered by a secondary caregiver. Those with increasing depressive symptoms were more likely to be white, patient's wife, have higher subjective caregiver burden, lower physical health, and care for a patient with greater functional limitations. CONCLUSIONS: Decreasing physical health was evident among caregivers who were initially healthier and reported less assistance from secondary caregivers. Increasing depression was seen in white, female spouses with higher subjective burden. Sample heterogeneity revealed hidden groups unexpectedly at risk in the primary cancer caregiver role to which the oncology care team should be alert.

Understanding cancer caregiver burden over time: Dyadic assessments of family cohesion, conflict and communication.

OBJECTIVE: Previously we identified three distinct cancer communication concordance groups among cancer patient-caregiver dyads. This secondary analysis examined patient and caregiver reports of family functioning (cohesion and conflict) as associated with cancer communication concordance and assessed each as independent predictors of perceived caregiver burden among hematological cancer caregivers. METHODS: A case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Using the previously identified communication groups this analysis prospectively examines patient and caregiver perceptions of family cohesion and conflict and the association with burden over time. RESULTS: Caregiver burden decreased over time. Caregiver, but not patient perceptions of family cohesion decreased over time; decreased cohesion and increased conflict was associated with greater cancer communication discordance. CONCLUSIONS: This work lends further support to the use of cancer communication congruence typologies for identifying potentially vulnerable dyads. Discordant cancer communication and declining caregiver perceptions of family cohesion may represent opportunities to intervene using family focused supportive services. PRACTICE IMPLICATIONS: Only caregiver perceptions of family functioning were associated with burden therefore identifying and supporting those caregivers with worsening communication and family function is important.

From adolescent daughter to mother: exploring message design strategies for breast and cervical cancer prevention and screening.

Early detection of breast and cervical cancers is one preventive behavior that may provide the adolescent daughter with a unique opportunity to provide encouragement to her mother or guardian to obtain screening. This study explored the design strategies necessary for developing an effective daughter-initiated message about screening for breast and cervical cancers. Thirty-two (N = 64) African-American mother-daughter dyads were interviewed about parenting style, goodwill, and daughters' credibility and risk behaviors that might influence receptivity toward a screening appeal. Mothers indicated that a tailored, emotional appeal combined with cancer facts delivered in a private setting would be most effective. Daughters were perceived as highly credible messengers and were perceived to have high levels of goodwill toward their mothers, regardless of risk behaviors.

Increasing tobacco quitline calls from pregnant african american women: the "one tiny reason to quit" social marketing campaign.

INTRODUCTION: Pregnant African American women are at disproportionately high risk of premature birth and infant mortality, outcomes associated with cigarette smoking. Telephone-based, individual smoking cessation counseling has been shown to result in successful quit attempts in the general population and among pregnant women, but "quitlines" are underutilized. A social marketing campaign called One Tiny Reason to Quit (OTRTQ) promoted calling a quitline (1-800-QUIT-NOW) to pregnant, African American women in Richmond, Virginia, in 2009 and was replicated there 2 years later. METHODS: The campaign disseminated messages via radio, interior bus ads, posters, newspaper ads, and billboards. Trained volunteers also delivered messages face-to-face and distributed branded give-away reminder items. The number of calls made from pregnant women in the Richmond area during summer 2009 was contrasted with (a) the number of calls during the seasons immediately before and after the campaign, and (b) the number of calls the previous summer. The replication used the same evaluation design. RESULTS: There were statistically significant spikes in calls from pregnant women during both campaign waves for both types of contrasts. A higher proportion of the calls from pregnant women were from African Americans during the campaign. CONCLUSION: A multimodal quitline promotion like OTRTQ should be considered for geographic areas with sizable African American populations and high rates of infant mortality.