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.

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.

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.

Communicating Effectively about Organ Donation: A Randomized Trial of a Behavioral Communication Intervention to Improve Discussions about Donation.

BACKGROUND: Families' refusal to authorize solid organ donation contributes to the organ deficit in the United States. The importance of communication to reducing refusal to requests for solid organ donation at the bedside and thus increasing the supply of transplantable organs cannot be overstated. This research compares two versions of an innovative communication skills training program for Organ Procurement Organization (OPO) request staff, Communicating Effectively About Donation (CEaD), designed to improve the quantity and quality of organ donation discussions with family decision makers (FDM) of deceased patients. METHODS: We conducted a parallel-group randomized controlled trial of the CEaD intervention, comparing an online only version of the training (CEaD1) with the online version bolstered with in-person practice and feedback (CEaD2). Survey and interview data were collected from 1,603 FDMs and 273 requesters to assess the impact of both versions of the CEaD on requesters' communication skills and behaviors; the rate of family authorization to solid organ donation were obtained from administrative data provided by 9 OPOs. RESULTS: Results revealed higher rates of authorization for requesters with less tenure (78% to 89%, p < .03) for both versions; however, CEaD1 also increased authorization rates for requesters with three or more years of experience (89% to 92%, p < .03). Both conditions resulted in an improvement in overall communication quality. CONCLUSIONS: We conclude that the CEaD was effective in improving requesters' communication skills, rates of family authorization to organ donation, and the overall quality of the donation experience.

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.

Convenience samples and caregiving research: how generalizable are the findings?

PURPOSE: We contrast characteristics of respondents recruited using convenience strategies with those of respondents recruited by random digit dial (RDD) methods. We compare sample variances, means, and interrelationships among variables generated from the convenience and RDD samples. DESIGN AND METHODS: Women aged 50 to 64 who work full time and provide care to a community-dwelling older person were recruited using either RDD (N = 55) or convenience methods (N = 87). Telephone interviews were conducted using reliable, valid measures of demographics, characteristics of the care recipient, help provided to the care recipient, evaluations of caregiver-care recipient relationship, and outcomes common to caregiving research. RESULTS: Convenience and RDD samples had similar variances on 68.4% of the examined variables. We found significant mean differences for 63% of the variables examined. Bivariate correlations suggest that one would reach different conclusions using the convenience and RDD sample data sets. IMPLICATIONS: Researchers should use convenience samples cautiously, as they may have limited generalizability.