Presentation on theme: "Male Caregivers of Breast Cancer Patients"— Presentation transcript:
1Male Caregivers of Breast Cancer Patients Sarah Dihmes, M.A.Mehran Habibi, M.D.
2Increase 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 oneNational Center on CaregivingAt 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 careYabroff and Kim, 200975% of married women diagnosed with breast cancer report receiving copious support from their spouse.Ciambrone & Allen, 2005Husbands comprise 30-50% of spousal caregiversCampbell & Carrol, 2007
3A Rise in Male Caregivers Kim, Loscalzo, Wellisch, & Spillers, 2006
4Why are there more male caregivers now? Human life span is increasing.Advances in medicineExpensive healthcare costsLimit feasibility o formal caregivingEvolution of Gender RolesParadigm shift in traditional male and female gender roles.
5Limited Research on Male Caregivers Men as control subjectsFocus 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
6Gender 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 behaviorsAsk for helpEmotionally copeIdentify 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.
8Adherence to Traditional Masculine Norms Traditional masculine norms commend:Self-reliancePhysical StrengthEmotional ControlHegemonic masculine beliefs, often thought of as societal ideals, prohibit some men from demonstrating typical DSM-IV symptoms of depression and caregiver burden.Emotional ExpressionMen who adhere to traditional masculine roles have more difficulty:Judging the non-verbal expressions of othersFind expressing their emotions more stressful
9DSM-IV Depressive Symptoms Male Specific Symptoms of Stress Measurement IssuesDSM-IV Depressive SymptomsMale Specific Symptoms of StressNon-Typical Depressive SymptomsCrying*Sadness*Guilt *Worthlessness *AnhedoniaAppetite/ weight changeSleep changeConcentration difficultiesFatiguePsychomotor retardation/ agitation*Not supported by traditional masculine beliefs.Drugs & alcoholAggression & irritabilityInterpersonal conflictPreoccupation with workMen who adhere to traditional masculine norms often experience stress through more masculine congruent behaviors and emotionsMagovcevic & Addis, 2008
10Analyses 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 CancerDoes the stage of breast cancer influence male caregivers’ experiences of stress?Types of TreatmentWill the types of treatment impact male caregivers’ experience of stress?
11This StudyApplication of the stress process model in husband caregivers of breast cancer patients
12The 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 FieldEstablished national standards for all caregiving research and clinical practice.Originally created from and for CGs with dementia
13Background and Context Conceptualized Model of Pearlin’s Cancer Caregiver Burden ModelMediatorsCoping & Social SupportPrimary StressorsObjective Indicators:Activities of Daily LivingInstrumental Activities of Daily LivingType of cancerTreatmentsSubjective Indicators:Patient’s level of painPatient’s mental healthSecondary StressorsRoles Strains:Family ConflictsOccupational StrainEconomic StrainSocial StrainIntrapsychic Strains:Self-EsteemMasteryLoss of SelfRole CaptivityCompetenceGainOutcomesDepressionAnxietyPhysical Health ProblemsIrascibilityGiving up Caring RoleBackground and ContextDemographics:AgeGenderCultureSESEducationPersonal historyCaregiving History:Caregiver’s relationship to patientLength of time delivering careSpecific health problems of cancer patientMarital quality pre-illnessMedical resource availability
14Operationalized Male Caregiver Burden Model MEDIATORSMarital SatisfactionShame & GuiltPRIMARY STRESSORSObjective Indicators:Activities of Daily LivingInstrumental Activities of Daily LivingType of cancerTreatmentsSubjective Indicators:Patient’s level of painPatient’s mental healthSecondary StressorsRoles Strains:Vocational environmentDomestic environmentSocial environmentSexual relationshipsExtended-familyrelationshipsPsychological distressOutcomesDepressionDSM-IV CriteriaA-typical SymptomsPhysical Health ProblemsBACKGROUND & CONTEXT VARIABLESDemographics:MalesAgeSESEducationPersonal historyCaregiving History:Relationship to patientLength of time delivering careSpecific health problems of cancer patientMODERATORExpressed Emotion from Wife
15Stress Process Model Domains Background & Social Context Control Factors: gender & ageHelp identify pts at riski.e. If gender is a risk factor, primary and secondary stressors may be different for females and males.DemographicsMost common: gender, age, ethnicity, marital qualityCaregiving HistoryFamily relationship to patient (i.e. husband)Length of time being a caregiverQuality of the relationshipSpecific health problems of the cancer patient.Background & Social ContextPrimary StressorsSecondary StressorsStress OutcomesDemographics:Caregiving History:MalesRelationship to patientAgeLength of time delivering careSESEducationSpecific health problems of cancer patientPersonal history
16Background & Social Context Primary StressorsSecondary StressorsStress OutcomesPrimary StressorsSecondary StressorsFactors that relate directly from the cancer and caregiving role.Disease Specific:Original Model: memory impairment & disruptive behaviorSubsequent stressors that may occur from primary.Caregiver’s experience of primary ongoing demandsVocational/ occupational strain is especially difficult for men.Objective Indicators:Subjective Indicators:Activities of Daily LivingPatient’s level of painInstrumental Activities of Daily LivingPatient’s mental healthType of cancerTreatmentsRoles Strains:Vocational environmentDomestic environmentSocial environmentSexual relationshipsExtended-familyrelationshipsPsychological distress
17Background & Social Context Primary StressorsSecondary StressorsStress OutcomesDepressionDSM-IV CriteriaA-typical SymptomsPhysical Health ProblemsStress Outcomes61% of caregivers suffered from depressionNational Family Caregivers Association, 2000Men & women caring for their ill spouses experience an increase in depression and decline in happinessNational Survey of Families and Households, 200931% of caregivers report that their role causes emotional stressNational Alliance for Caregiving & AARP, 2009
18Mediators Marital Satisfaction Shame & Guilt Independent variables cause the mediator, and the mediator causes the dependent variableIntermediary factor of the causal pathwayMarital SatisfactionPsychological 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 & GuiltCorrelate with onset and maintenance of psychopathology.Individuals who are shame prone are at increased risk for MH disorders.
19Moderator Expressed Emotion from Wife Interactions between the independent and dependent variables that can strengthen, weaken, or account for the relationships between the two – MacKinnon, 2008Expressed Emotion from WifeDefinition: 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 patientButzlaff & Hooley, 1998; Forin et al., 1992Depressed patients living with
20Type of Variable Variables Measures/ Instruments Source of Report Independent Variables:Background Factors Demographics Demographic Form1 Male CaregiverPrimary Stressors Patient’s Overall FACT-B 2 Male CaregiverWell-BeingCaregiver Duties Activities of Daily Living Male CaregiverCaregiver Tasks Instrumental Activities Male Caregiverof Daily LivingSecondary Stressors Role Strains Psychological Adjustment Male Caregiverto Illness ScalePotential Mediator Marital Satisfaction Revised Dyadic Male CaregiverAdjustment ScaleExpressed Emotion Five Minute Speech Sample Female PatientPotential Moderators Shame & Guilt Personal Feeling Male CaregiverQuestionnaire-2Outcome Variables Caregiver Depression Beck Depression Inventory-II Male CaregiverMasculine Depression Masculine Depression Scale Male CaregiverSymptomsPhysical Health Problems SF-12 Male CaregiverDependent 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.
21Men Against Breast Cancer Do educational resources help?Do male caregivers who attend workshops and educational seminars experience less stress than men who do not?
22Medical 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?