A Multimodal Mind-Body Intervention for Fear of Recurrence among Cancer Survivors

针对癌症幸存者复发恐惧的多模式身心干预

• 批准号: 10216182
• 负责人: Daniel Lee Hall
• 金额: $ 15.74万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10216182
• 关键词: Aftercare; Behavioral; Breathing; Cancer Intervention; Cancer Survivor; Cancer Survivorship; Cardiovascular Diseases; Chronic; Clinical; Clinical Research; Clinical Trials; Clinical Trials Design; Cognitive; Compassion; Conflict (Psychology); Coping Skills; Data; Data Analyses; Data Collection; Diagnosis; Distress; Doctor of Philosophy; Educational process of instructing; Emotional; Enrollment; Environment; Evaluation; Feedback; Focus Groups; Fostering; Foundations; Frequencies; Fright; Funding; Goals; Growth; HIV; Health; Healthcare; Impairment; Individual; Intervention; Interview; Journals; K-Series Research Career Programs; Lead; Life; Link; Logistics; Malignant Neoplasms; Medical; Meditation; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Meta-Analysis; Methods; Mind-Body Intervention; Modeling; Morbidity - disease rate; Multiple Sclerosis; Myocardial Infarction; Nonmetastatic; Outcome; Patient Self-Report; Patients; Pattern; Peer Review; Persons; Population; Positioning Attribute; Postdoctoral Fellow; Prevalence; Procedures; Protocols documentation; Provider; Psychology; Publishing; Randomized; Randomized Controlled Trials; Recommendation; Recording of previous events; Recurrence; Relaxation; Reporting; Research; Research Personnel; Research Training; Resources; Risk; Sampling; Science; Severities; Support Groups; Surveys; Survivors; Symptoms; Techniques; Testing; Time; Training; Uncertainty; Videoconferencing; Visit; Yoga; acceptability and feasibility; body-mind; cancer recurrence; cancer type; chronic pain; cohesion; design; dosage; evidence base; follow-up; improved; ineffective therapies; longitudinal analysis; malignant breast neoplasm; meetings; mindfulness; mindfulness meditation; mortality; multimodality; preference; programs; protective factors; psychologic; resilience; response; satisfaction; screening; skills; symposium; symptom management; systematic review; treatment as usual; unnecessary treatment

PROJECT SUMMARY This K23 career development award will position the candidate to become an independent clinical researcher with expertise in refining and testing mind-body interventions for managing fears of illness recurrence and associated healthcare engagement among medical patients. BACKGROUND. Fear of recurrence (FOR) is a common, highly distressing difficulty faced by individuals with a history of chronic and/or life-threatening illness. For example, cancer survivors, a growing population, report clinically-elevated FOR as a chief psychological concern. Notably, FOR may lead to worsened clinical outcomes, due to maladaptive healthcare engagement (e.g., avoidance or overuse of follow-up screenings). It is critical to develop evidence-based FOR interventions. Relaxation skills, mindfulness meditation, cognitive-behavioral skills, and positive psychology techniques are promising for reducing FOR in cancer survivors, yet trials have been limited by testing these skills in isolation and among homogenous samples (e.g., breast cancer only). SPECIFIC AIMS. The proposed studies employ mixed methods designs to: (1) refine a multimodal, mind-body intervention (Relaxation Response Resiliency Program) to target FOR among cancer survivors via tiered feedback from focus groups, individual interviews, and an interdisciplinary expert panel, (2) evaluate, in a pilot RCT, its feasibility and acceptability among cancer survivors with elevated FOR, and (3) explore within-group, longitudinal patterns of FOR, healthcare engagement, and their covariance across multiple timepoints. TRAINING. The candidate will achieve short- term goals through a resource-rich institutional environment and a cohesive training plan in (1) clinical trial design, (2) mixed methods and longitudinal data collection and analysis, and (3) evaluation of healthcare engagement. In addition to ongoing mentorship meetings and experiential training through the research plan, the candidate will complete targeted coursework, didactic trainings, and shadowing, present at local and national conferences, and publish in peer-reviewed journals. MENTORSHIP. The candidate will be supported by a stellar mentoring team: Elyse R. Park, PhD, MPD (primary mentor), Gloria Y. Yeh, MD, MPH (co-mentor), Conall O’Cleirigh, PhD (co-mentor), John Denninger, MD, PhD (consultant), Hang Lee, PhD (consultant), Jeffrey Peppercorn, MD, MPH (consultant), and Lynne Wagner, PhD (consultant). IMPACT. In line with NCCIH funding priorities, the proposed research will answer critical questions about (1) the feasibility and acceptability of mind-body approaches for hard-to-manage symptoms and (2) potential mechanisms underlying resiliency. While initial studies will focus on cancer survivors, it is anticipated that the candidate’s training and research will have broad applications to a variety of medical populations struggling with uncertainty about illness recurrence. Through this K23 award, the candidate will gain the training and preliminary data needed to apply for a larger NCCIH clinical trial (e.g., R01 or U01) to determine the optimal integration and dosage of mind- body skills for managing FOR and potential downstream effects on healthcare engagement.

项目总结 K23职业发展奖将使候选人成为一名独立的临床研究人员 拥有完善和测试心身干预措施的专业知识，以管理对疾病复发和 医疗患者的相关医疗参与度。背景资料。对复发的恐惧是一种 有慢性病和/或危及生命的病史的个人所面临的常见、非常令人痛苦的困难。 例如，癌症幸存者，不断增长的人口，报告说临床上被提升为主要的心理疾病 担忧。值得注意的是，由于不适应的医疗保健参与，FOR可能会导致更糟糕的临床结果 (例如，避免或过度使用后续筛查)。制定干预措施的循证依据至关重要。 放松技巧、正念冥想、认知行为技巧和积极心理学技巧是 有望减少癌症幸存者的死亡率，但试验因孤立地测试这些技能而受到限制 以及在同质样本中(例如，仅乳腺癌)。明确的目标。拟议的研究采用了 混合方法的设计目的是：(1)改进多模式、身心干预(松弛反应弹性 计划)通过来自焦点小组的分层反馈、个人访谈、 和一个跨学科专家小组，(2)在试验性随机对照试验中评估其在癌症中的可行性和可接受性 (3)探索组内医疗保健的纵向模式 参与度，以及它们在多个时间点的协变性。训练。候选人将实现短期- 在(1)临床试验中通过资源丰富的制度环境和连贯的培训计划实现任期目标 设计，(2)混合方法和纵向数据收集和分析，以及(3)医疗保健评估 订婚。除了正在进行的导师会议和通过研究计划进行的体验式培训外， 候选人将完成有针对性的课程作业、教学培训和影子训练，在当地和 国家会议，并在同行评议的期刊上发表。师徒关系。候选人将获得支持 由优秀的导师团队：Elyse R.Park博士，MPD(主要导师)，Gloria Y.Yeh，医学博士，公共卫生硕士(共同导师)， Conall O‘Cleirigh博士(共同导师)、John Denninger医学博士(顾问)、Hang Lee博士(顾问)、 杰弗里·佩珀科恩，医学博士，公共卫生硕士(顾问)和林恩·瓦格纳博士(顾问)。冲击力。符合NCCIH 根据资金优先顺序，拟议的研究将回答以下关键问题：(1)可行性和可接受性 针对难以控制的症状的身心方法，以及(2)潜在的复原力机制。 虽然初步研究将集中在癌症幸存者身上，但预计候选人的培训和研究 将广泛应用于与疾病的不确定性作斗争的各种医疗人群 复发。通过这个K23奖项，候选人将获得申请所需的培训和初步数据 对于较大的NCCIH临床试验(例如，R01或U01)，以确定Mind的最佳整合和剂量- 身体技能，以管理和潜在的下游影响的医疗保健参与。