The objective of this application for a K23 award is to provide additional training and mentored research experience for Dr. Boyoung Hwang to establish herself as an independent investigator in clinical research that is focused on the improvement of the health and well-being of caregivers of HF patients, and subsequently, of the HF patients themselves. The career development plan consists of obtaining training in design and implementation of randomized clinical trials, advanced biostatistical methods, cognitive behavioral interventions, and salivary biomarkers of stress. To achieve her training goals, Dr. Hwang has developed a focused research study and assembled an outstanding mentoring team comprised of a primary mentor, Dr. Lynn Doering, Professor of School of Nursing at UCLA, who is an expert in biobehavioral research in cardiovascular disease and cognitive behavioral therapy, and two co-mentors: Dr. Mary-Lynn Brecht, Biostatistician at UCLA, who has expertise in study design and complex biostatistical analysis;and Dr. Douglas A. Granger, Professor of Nursing, Public Health, and Medicine at the Johns Hopkins University, who is an expert in salivary biomarker research. Heart failure (HF) is a prevalent and debilitating disease. While support from family caregivers is crucial for better outcomes for HF patients, caring for a chronically ill family member can be challenging and stressful. It has been reported that HF caregivers are distressed and socially isolated due to their care responsibilities, perceive their health to be compromised, and suffer from poor quality of life. However, the literature lacks a comprehensive description of the health status of HF caregivers;no intervention study aimed at alleviating stress in HF caregivers has been reported to date. To fill these gaps, Dr. Hwang will conduct a pilot randomized clinical trial with 50 dyads of HF patients and their caregivers. The study will provide a comprehensive description of health problems and symptoms that caregivers experience (Aim 1) and evaluate the potential of a cognitive behavioral (CB) intervention designed to reduce stress and improve knowledge about HF care and perceived social support among caregivers. Using salivary cortisol measures, the study will examine how psychological benefits from the intervention lead to improvement in caregiver health. Specifically, the study will provide preliminary effect sizes of an 8-week CB caregiver intervention on psychological stress responses (i.e., perceived stress, caregiver stress, and depression), physiological stress responses (i.e., salivary cortisol), stress-related symptoms, health-related quality of life, and health care usage of caregivers. Clinical outcomes of HF patients will also be measured to determine the effects of this caregiver intervention on care recipients (Aim 2). Finally, the potential mediating effects of knowledge about HF care and perceived social support on changes in psychological stress responses and caregiver health will be examined (Aim 3). The study will provide critical pilot data to support an R01 application for a large randomized clinical trial.
Caregivers are vulnerable to health problems because of the stress and demands of their role as a caregiver. With the growing incidence of HF and the anticipated growth in the aging population, the number of HF caregivers is expected to rise. Therefore, the project will pilot test a cognitive behavioral intervention designed to reduce stres and improve knowledge about HF care and perceived social support among HF caregivers, which will ultimately contribute to promoting health and quality of life among HF caregivers and their loved ones with HF.