A Psychosocial Intervention to Improve Outcomes for Parents with Advanced Cancer

改善晚期癌症父母预后的社会心理干预

• 批准号: 10219984
• 负责人: ELIZA Myung PARK
• 金额: $ 17.68万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2023-04-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10219984
• 关键词: Address; Adult; Advance Care Planning; Advanced Malignant Neoplasm; Affect; Age; American; Anxiety; Award; Cessation of life; Child; Child Rearing; Child Welfare; Communication; Counseling; Data; Decision Making; Distress; Education; Environment; Family; Feeling; Future; Goals; Healthcare; Hospitals; Individual; Intervention; Interview; K-Series Research Career Programs; Link; Location; Malignant Neoplasms; Measures; Mental Depression; Mental Health; Mentorship; Metastatic breast cancer; Mothers; Motivation; Oncology; Outcome; Outcome Measure; Palliative Care; Parents; Patient-Centered Care; Patient-Focused Outcomes; Patients; Physicians; Population; Preparation; Process; Prognosis; Program Development; Psychiatrist; Psychiatry; Psychotherapy; Publications; Quality of life; Randomized Controlled Trials; Readiness; Reporting; Research; Research Personnel; Research Training; Resources; Role; Scientist; Structure; Testing; Therapeutic Intervention; Training; Training and Education; Treatment Efficacy; United States; Visit; Woman; behavior change; career; career development; caregiver bereavement; caregiving; commune; coping; design; effective intervention; end of life; experience; implementation science; improved; improved outcome; informant; malignant breast neoplasm; palliative; post intervention; premature; primary caregiver; primary outcome; psychologic; psychological distress; psychological outcomes; psychosocial; secondary outcome; theories

ABSTRACT Cancer is a leading cause of premature death for parents of dependent children in the United States. Parents with advanced cancer experience profound psychological suffering and many are inadequately prepared for the decisions and consequences associated with their progressive illness and death. Yet there are no effective interventions to reduce psychological distress for these patients. The proposed study addresses this critical gap: we will develop and pilot test a theory-guided psychosocial intervention tailored for parents with advanced cancer and their co-parents (together as a dyad) to reduce their psychological distress and improve end-of-life (EOL) preparation. We will first develop the intervention—psychotherapy counseling visits structured to promote dyadic communication about parenting concerns, using key stakeholder interviews, and then conduct a randomized controlled trial (RCT) with 60 mothers with metastatic breast cancer and their co-parents (an adult identified by the patient to serve as the child(ren)’s primary caregiver if she were to become unavailable). Specific research aims are: (1) to develop a unique, tailored psychosocial intervention to reduce psychological distress in mothers with metastatic breast cancer and their co-parents; and (2) to evaluate the feasibility, acceptability and preliminary evidence for efficacy of the intervention, in a pilot RCT. We hypothesize that improved dyadic communication about parenting concerns and EOL preparation will reduce patients’ and co- parents’ depression and anxiety. The primary outcome is psychological distress, measured by the Hospital Anxiety and Depression Scale, in patients and co-parents. Secondary outcomes are dyadic communication quality, parenting concerns, EOL preparation - defined as advance care planning for healthcare decisions and parenting, and quality of life. Outcomes will be measured at baseline, 4-, 8-, and 12-weeks (post-intervention). Dr. Park is a psychiatrist with advanced training in psycho-oncology whose long-term goal is to develop and test psychosocial interventions to improve outcomes for patients and families affected by parental advanced cancer. Her short-term career goals for this award are to: (1) obtain education and hands-on training in the design of theory-guided, family-centered psychosocial interventions in oncology; (2) obtain education and training to design, conduct, and evaluate RCTs of psychosocial interventions; (3) acquire education in implementation science to become skilled in the design and testing of pragmatic and sustainable psychosocial interventions in oncology; and (4) develop the expertise, pilot data, and publication record necessary to be an independent investigator. The mentorship and research training resources at UNC create an ideal environment for this career development award. Dr. Park is committed to a research career as a physician scientist and she is uniquely qualified to conduct this study given her research focus on the intersection of psychiatry, oncology and palliative care. This award provides Dr. Park with the necessary education, experiential training, and pilot data for a future large RCT to achieve her long-term goals. 1

摘要 癌症是美国受抚养儿童父母过早死亡的主要原因。父母 患有晚期癌症的人经历了深刻的心理痛苦，许多人没有做好充分的准备 与他们的疾病进展和死亡相关的决定和后果。然而，没有有效的 干预措施，以减少这些患者的心理困扰。拟议的研究解决了这一关键问题， 差距：我们将开发和试点测试一个理论指导的心理社会干预，为父母量身定制的先进的 癌症患者及其共同父母（作为一对），以减轻他们的心理困扰并改善临终关怀 (EOL)准备.我们将首先制定干预心理治疗咨询访问结构， 通过与主要利益相关者的访谈，促进关于育儿问题的二元沟通，然后进行 一项随机对照试验（RCT）纳入了60名患有转移性乳腺癌的母亲及其共同父母（ 由患者指定的成年人担任儿童的主要照顾者（如果她变得不可用）。 具体的研究目标是：（1）制定独特的、量身定制的心理社会干预措施，以减少心理 患有转移性乳腺癌的母亲及其共同父母的痛苦;和（2）评估可行性， 可接受性和干预有效性的初步证据，在试点RCT中。我们假设 改善父母关系和EOL准备的双向沟通将减少患者的焦虑和共同焦虑。 父母的抑郁和焦虑。主要结果是由医院测量的心理困扰 焦虑和抑郁量表，患者和共同父母。次要结果是二元沟通 质量、养育问题、EOL准备-定义为医疗保健决策的提前护理计划， 养育子女和生活质量。将在基线、4周、8周和12周（干预后）测量结局。 博士Park是一名精神病学家，在心理肿瘤学方面接受过高级培训，其长期目标是发展和 测试心理社会干预措施，以改善受父母先进影响的患者和家庭的结果 癌她的短期职业目标是：（1）获得教育和实践培训， 在肿瘤学中设计以理论为指导、以家庭为中心的心理社会干预措施;（2）获得教育， 设计、实施和评估心理干预RCT的培训;（3）获得以下方面的教育： 实施科学成为熟练的设计和测试务实和可持续的心理社会 肿瘤学干预措施;（4）发展必要的专业知识，试点数据和出版记录， 独立调查员导师制和研究培训资源，创造了一个理想的环境， 获得职业发展奖Park博士致力于作为一名医生科学家的研究事业，她 由于她的研究重点是精神病学、肿瘤学、 和姑息治疗该奖项为朴博士提供了必要的教育，体验式培训和试点 为未来的大型RCT提供数据，以实现她的长期目标。 1

项目成果

Addressing Child Custody Concerns of Parents with Life-Limiting Illness.

解决患有致命疾病的父母的儿童监护问题。

• DOI: 10.1089/jpm.2019.0293
• 发表时间: 2020
• 期刊: Journal of palliative medicine
• 影响因子: 2.8
• 作者: Nelson,CourtneyA;Stanton,KateE;Bowers,SavannahM;Park,ElizaM
• 通讯作者: Park,ElizaM

Understanding familial response to parental advanced cancer using the family management style framework.

使用家庭管理风格框架了解家族对父母晚期癌症的反应。

• DOI: 10.1080/07347332.2019.1614132
• 发表时间: 2019
• 期刊: Journal of psychosocial oncology
• 影响因子: 2.1
• 作者: Park,ElizaM;Miller,KaitlynL;Knafl,KathleenA
• 通讯作者: Knafl,KathleenA

Parenting through grief: A cross-sectional study of recently bereaved adults with minor children.

• DOI: 10.1177/02692163211040982
• 发表时间: 2021-12
• 期刊: Palliative medicine
• 影响因子: 4.4
• 作者: Park EM;Deal AM;Yopp JM;Chien SA;McCabe S;Hirsch A;Bowers SM;Edwards T;Rosenstein DL
• 通讯作者: Rosenstein DL

Implementation of a Psychiatry Consultation-Liaison Service "Conseminar".

实施精神病学咨询联络服务“研讨会”。

• DOI: 10.1016/j.jaclp.2020.12.010
• 发表时间: 2021
• 期刊: Journal of the Academy of Consultation-Liaison Psychiatry
• 影响因子: 2.3
• 作者: Reddy,Rishika;Gerkin,JonathanS;Laughon,SarahL;Nash,RebekahP;Sowa,NateA;Park,ElizaM;Gala,GaryJ;Rosenstein,DonaldL
• 通讯作者: Rosenstein,DonaldL

Survivorship Care of Older Adults With Cancer: Priority Areas for Clinical Practice, Training, Research, and Policy.

老年癌症患者的生存护理：临床实践、培训、研究和政策的优先领域。

• DOI: 10.1200/jco.21.00226
• 发表时间: 2021
• 期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology
• 作者: Kent,ErinE;Park,ElizaM;Wood,WilliamA;Bryant,AshleyLeak;Mollica,MichelleA
• 通讯作者: Mollica,MichelleA