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Male Caregivers of Breast Cancer Patients

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Presentation on theme: "Male Caregivers of Breast Cancer Patients"— Presentation transcript:

1 Male Caregivers of Breast Cancer Patients
Sarah Dihmes, M.A. Mehran Habibi, M.D.

2 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 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. National Alliance for Caregiving & American Association of Retired Persons, 2009). 99% of cancer patients were receiving informal care Yabroff and Kim, 2009 75% of married women diagnosed with breast cancer report receiving copious support from their spouse. Ciambrone & Allen, 2005 Husbands comprise 30-50% of spousal caregivers Campbell & Carrol, 2007

3 A Rise in Male Caregivers
Kim, Loscalzo, Wellisch, & Spillers, 2006

4 Why are there more male caregivers now?
Human life span is increasing. Advances in medicine Expensive healthcare costs Limit feasibility o formal caregiving Evolution of Gender Roles Paradigm shift in traditional male and female gender roles.

5 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. Men have been used as control subjects to study female caregivers

6 Gender Differences in Caregiving Who copes better?
Men are LESS likely to: Men are MORE likely to: Seek support for their own 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. Provide physical care. Perform more tasks related to hygiene, communication, mobility, dressing and feeding. Sacrifice gendered roles in the family. Work outside the home while being a caregiver. Accept caregiving as an extension of their marital vows. Use a stoic approach.

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8 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 Men who adhere to traditional masculine roles have more difficulty: Judging the non-verbal expressions of others Find expressing their emotions more stressful

9 DSM-IV Depressive Symptoms Male Specific Symptoms of Stress
Measurement Issues DSM-IV Depressive Symptoms Male Specific Symptoms of Stress Non-Typical Depressive Symptoms Crying* Sadness* Guilt * Worthlessness * Anhedonia Appetite/ weight change Sleep change Concentration difficulties Fatigue Psychomotor retardation/ agitation *Not supported by traditional masculine beliefs. Drugs & alcohol Aggression & irritability Interpersonal conflict Preoccupation with work Men who adhere to traditional masculine norms often experience stress through more masculine congruent behaviors and emotions Magovcevic & Addis, 2008

10 Analyses Compliance Stage of Cancer Types of Treatment
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?

11 This Study Application of the stress process model in husband caregivers of breast cancer patients

12 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 Established national standards for all caregiving research and clinical practice. Originally created from and for CGs with dementia

13 Background and Context
Conceptualized Model of Pearlin’s Cancer Caregiver Burden Model Mediators Coping & Social Support 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 Outcomes Depression Anxiety Physical Health Problems Irascibility Giving up Caring Role 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

14 Operationalized Male Caregiver Burden Model
MEDIATORS Marital Satisfaction Shame & Guilt 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: Vocational environment Domestic environment Social environment Sexual relationships Extended-family relationships Psychological distress Outcomes Depression DSM-IV Criteria A-typical Symptoms Physical Health Problems BACKGROUND & CONTEXT VARIABLES Demographics: Males Age SES Education Personal history Caregiving History: Relationship to patient Length of time delivering care Specific health problems of cancer patient MODERATOR Expressed Emotion from Wife

15 Stress Process Model Domains Background & Social Context
Control Factors: gender & age Help identify pts at risk i.e. If gender is a risk factor, primary and secondary stressors may be different for females and males. Demographics Most common: gender, age, ethnicity, marital quality 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. Background & Social Context Primary Stressors Secondary Stressors Stress Outcomes Demographics: Caregiving History: Males Relationship to patient Age Length of time delivering care SES Education Specific health problems of cancer patient Personal history

16 Background & Social Context
Primary Stressors Secondary Stressors Stress Outcomes Primary Stressors Secondary Stressors Factors that relate directly from the cancer and caregiving role. Disease Specific: Original Model: memory impairment & disruptive behavior Subsequent stressors that may occur from primary. Caregiver’s experience of primary ongoing demands Vocational/ occupational strain is especially difficult for men. Objective Indicators: Subjective Indicators: Activities of Daily Living Patient’s level of pain Instrumental Activities of Daily Living Patient’s mental health Type of cancer Treatments Roles Strains: Vocational environment Domestic environment Social environment Sexual relationships Extended-family relationships Psychological distress

17 Background & Social Context
Primary Stressors Secondary Stressors Stress Outcomes Depression DSM-IV Criteria A-typical Symptoms Physical Health Problems Stress Outcomes 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 National Alliance for Caregiving & AARP, 2009

18 Mediators Marital Satisfaction Shame & Guilt
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.

19 Moderator Expressed Emotion from Wife
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 Butzlaff & Hooley, 1998; Forin et al., 1992 Depressed patients living with

20 Type of Variable Variables Measures/ Instruments Source of Report
Independent Variables: Background Factors Demographics Demographic Form1 Male Caregiver Primary Stressors Patient’s Overall FACT-B 2 Male Caregiver Well-Being Caregiver Duties Activities of Daily Living Male Caregiver Caregiver Tasks Instrumental Activities Male Caregiver of Daily Living Secondary Stressors Role Strains Psychological Adjustment Male Caregiver to Illness Scale Potential Mediator Marital Satisfaction Revised Dyadic Male Caregiver Adjustment Scale Expressed Emotion Five Minute Speech Sample Female Patient Potential Moderators Shame & Guilt Personal Feeling Male Caregiver Questionnaire-2 Outcome Variables Caregiver Depression Beck Depression Inventory-II Male Caregiver Masculine Depression Masculine Depression Scale Male Caregiver Symptoms Physical Health Problems SF-12 Male Caregiver Dependent Variables: 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.

21 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?

22 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?


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