Transcript Male Caregivers of Breast Cancer Patients

Male Caregivers of Breast
Cancer Patients
SARAH DIHMES, M.A.
MEHRAN HABIBI, M.D.
Increase in Male Caregivers
The number of cancer patients receiving informal care at home
is at an all-time high.
 66 million Americans (3 out of 10 homes) have a family member delivering
informal care to a loved one
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National Center on Caregiving
At least 50% of the 1.3 million cancer diagnoses will be cared for by
someone in the patient’s immediate family.
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National Alliance for Caregiving & American Association of Retired Persons, 2009).
 99% of cancer patients were receiving informal care
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Yabroff and Kim, 2009
 75% of married women diagnosed with breast cancer report receiving
copious support from their spouse.
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Ciambrone & Allen, 2005
 Husbands comprise 30-50% of spousal caregivers
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Campbell & Carrol, 2007
A Rise in Male Caregivers
Kim, Loscalzo, Wellisch, & Spillers, 2006
Why are there more male caregivers now?
 Human life span is
increasing.
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Advances in medicine
 Expensive healthcare
costs
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Limit feasibility o formal
caregiving
 Evolution of Gender
Roles
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Paradigm shift in
traditional male and
female gender roles.
Limited Research on Male Caregivers
 Men as control subjects
 Focus is on elderly
husbands caring for
wives with Alzheimer’s
disease.
 Lack of explanatory
framework about men’s
experiences.
Gender Differences in Caregiving
Who copes better?
Men are LESS likely to:
Men are MORE likely to:
 Seek support for their own
 Provide physical care.
 Perform more tasks related to
hygiene, communication,
mobility, dressing and feeding.
 Sacrifice gendered roles in
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physical and mental health
needs.
Report exacerbated
physical ailments
associated with giving care.
Practice health promoting
behaviors
Ask for help
Emotionally cope
Identify themselves as
caregivers.
the family.
 Work outside the home
while being a caregiver.
 Accept caregiving as an
extension of their marital
vows.
 Use a stoic approach.
www.mengetdepression.com
Adherence to Traditional Masculine Norms
 Traditional masculine norms commend:
 Self-reliance
 Physical Strength
 Emotional Control
 Hegemonic masculine beliefs, often thought of as societal ideals,
prohibit some men from demonstrating typical DSM-IV
symptoms of depression and caregiver burden.
 Emotional Expression
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Men who adhere to traditional masculine roles have more difficulty:
Judging the non-verbal expressions of others
 Find expressing their emotions more stressful
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Measurement Issues
DSM-IV Depressive Symptoms
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Crying*
Sadness*
Guilt *
Worthlessness *
Anhedonia
Appetite/ weight change
Sleep change
Concentration difficulties
Fatigue
Psychomotor retardation/ agitation
Male Specific Symptoms of Stress
Non-Typical Depressive Symptoms
 Drugs & alcohol
 Aggression &
irritability
 Interpersonal conflict
 Preoccupation with
work
*Not supported by traditional masculine
beliefs.
Men who adhere to traditional masculine norms often experience stress through more
masculine congruent behaviors and emotions
Magovcevic & Addis, 2008
Analyses
 Compliance
 Will compliance differ between those who completed the
survey in the clinic compared to those who completed the
survey online?
 Stage of Cancer
 Does the stage of breast cancer influence male caregivers’
experiences of stress?
 Types of Treatment
 Will the types of treatment impact male caregivers’ experience
of stress?
This Study
APPLICATION OF THE STRESS
PROCESS MODEL IN HUSBAND
CAREGIVERS OF BREAST CANCER
PATIENTS
The Stress Process Model
 2006: Family Caregiver Alliance held a national
conference to bring together researchers,
policymakers, and practitioners.
 They produced a report: Caregiver Assessment:
Voices and Views from the Field
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Established national standards for all caregiving research
and clinical practice.
 Originally created from and for CGs with dementia
Conceptualized Model of Pearlin’s Cancer Caregiver Burden Model
Background and Context
Demographics:
-Age
-Gender
- Culture
-SES
-Education
-Personal history
Caregiving History:
-Caregiver’s relationship
to patient
-Length of time delivering care
-Specific health problems of
cancer patient
-Marital quality pre-illness
-Medical resource availability
Primary Stressors
Objective Indicators:
-Activities of Daily
Living
-Instrumental Activities of Daily
Living
-Type of cancer
-Treatments
Subjective Indicators:
-Patient’s level of pain
-Patient’s mental health
Secondary Stressors
Roles Strains:
-Family Conflicts
-Occupational Strain
-Economic Strain
-Social Strain
Intrapsychic Strains:
-Self-Esteem
-Mastery
-Loss of Self
-Role Captivity
-Competence
-Gain
Mediators
Coping & Social Support
Outcomes
-Depression
-Anxiety
-Physical Health Problems
-Irascibility
-Giving up Caring Role
Operationalized Male Caregiver Burden Model
BACKGROUND & CONTEXT
VARIABLES
PRIMARY
STRESSORS
•Demographics:
•Males
•Age
•SES
•Education
•Personal history
•Caregiving History:
•Relationship to patient
•Length of time delivering care
•Specific health problems of cancer
patient
•Objective Indicators:
•Activities of Daily Living
•Instrumental Activities of
Daily Living
•Type of cancer
•Treatments
•Subjective Indicators:
•Patient’s level of pain
•Patient’s mental health
MEDIATORS
•Marital Satisfaction
•Shame & Guilt
Secondary Stressors
•Roles Strains:
•Vocational environment
•Domestic environment
•Social environment
•Sexual relationships
•Extended-family
relationships
•Psychological distress
MODERATOR
•Expressed Emotion from Wife
Outcomes
•Depression
•DSM-IV Criteria
•A-typical Symptoms
•Physical Health
Problems
Stress Process Model Domains
Background & Social Context
 Control Factors: gender & age
 Help identify pts at risk
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i.e. If gender is a risk factor,
primary and secondary stressors
may be different for females and
males.
 Demographics
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Most common: gender, age,
ethnicity, marital quality
Background &
Social Context
•Demographics:
•Males
•Age
•SES
•Education
•Personal history
•Caregiving History:
•Relationship to patient
•Length of time
delivering care
•Specific health
problems of cancer
patient
Primary
Stressors
 Caregiving History
 Family relationship to
patient (i.e. husband)
 Length of time being a
caregiver
 Quality of the relationship
 Specific health problems of
the cancer patient.
Secondary
Stressors
Stress
Outcomes
Primary
Stressors
Background &
Social Context
Secondary
Stressors
Secondary Stressors
Primary Stressors
• Factors that relate directly from
the cancer and caregiving
role.
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Disease Specific:
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Original Model: memory
impairment & disruptive
behavior
Objective Indicators:
•Activities of Daily
Living
•Instrumental
Activities of Daily
Living
•Type of cancer
•Treatments
Subjective
Indicators:
•Patient’s level of
pain
•Patient’s mental
health
Stress
Outcomes
 Subsequent stressors that may
occur from primary.
•
Caregiver’s experience of
primary ongoing demands
•
Vocational/ occupational strain is
especially difficult for men.
Roles Strains:
•Vocational environment
•Domestic environment
•Social environment
•Sexual relationships
•Extended-family
relationships
•Psychological distress
Primary
Stressors
Background &
Social Context
Stress
Outcomes
Secondary
Stressors
Stress Outcomes
•Depression
•DSM-IV Criteria
•A-typical Symptoms
•Physical Health Problems
• 61% of caregivers suffered from depression
• National Family Caregivers Association, 2000
• Men & women caring for their ill spouses experience an
increase in depression and decline in happiness
•
National Survey of Families and Households, 2009
• 31% of caregivers report that their role causes
emotional stress
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National Alliance for Caregiving & AARP, 2009
Mediators
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Independent variables cause the mediator, and the mediator
causes the dependent variable
Intermediary factor of the causal pathway
 Marital Satisfaction
 Psychological adjustment the marriage must undergo after a
diagnosis of cancer.
 Can exacerbate or strengthen emotional bonds.
 Pre-illness quality of the relationship is also important.
 Shame & Guilt
 Correlate with onset and maintenance of psychopathology.
 Individuals who are shame prone are at increased risk for MH
disorders.
Moderator
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Interactions between the independent and dependent
variables that can strengthen, weaken, or account for the
relationships between the two – MacKinnon, 2008
 Expressed Emotion from Wife
 Definition: the extent to which a family member of a distressed
individual expressed critical, hostile, or emotionally
overinvolved statements towards their distressed family
member.
 Higher EE in a spouse predicts higher depression symptoms in
the depressed patient
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Butzlaff & Hooley, 1998; Forin et al., 1992
Depressed patients living with
Type of Variable
Variables
Measures/ Instruments
Source of Report
Independent Variables:
Background Factors
Primary Stressors
Secondary Stressors
Demographics
Patient’s Overall
Well-Being
Caregiver Duties
Caregiver Tasks
of Daily Living
Role Strains
Potential Mediator
Marital Satisfaction
Potential Moderators
Expressed Emotion
Shame & Guilt
Demographic Form1
FACT-B 2
Male Caregiver
Male Caregiver
Activities of Daily Living
Instrumental Activities
Male Caregiver
Male Caregiver
Psychological Adjustment
to Illness Scale
Revised Dyadic
Adjustment Scale
Five Minute Speech Sample
Personal Feeling
Questionnaire-2
Male Caregiver
Male Caregiver
Female Patient
Male Caregiver
Dependent Variables:
Outcome Variables
Caregiver Depression
Beck Depression Inventory-II
Masculine Depression
Masculine Depression Scale
Symptoms
Physical Health Problems SF-12
Male Caregiver
Male Caregiver
Male Caregiver
Note. 1Caregivers demographics: age, culture, SES, education, medical information, mental illness history, and length of time delivering care.
2 Functional Assessment of Cancer Therapy- Breast (FACT-B) subscales: physical, emotional, functional well-being, social/ family, and
additional concerns.
Men Against Breast Cancer
 Do educational resources help?
 Do male caregivers who attend workshops and educational
seminars experience less stress than men who do not?
Medical Setting
 Is there a difference between medical settings?
 Do the male caregivers whose wives are receiving treatment at
Johns Hopkins University experience stress differently than
male caregivers whose wives are being treated at private
oncologists’ offices?