Development of A Mindfulness-Based Mobile Health Intervention for Patients Coping with Pain from Advanced Malignancies

项目总结 疼痛影响着大约三分之二的晚期、无法治愈的癌症患者，其发生率接近90%。 在生命的尽头。晚期癌症疼痛可能是出了名的严重，降低了患者的情感，社交， 和功能上的幸福。晚期癌症疼痛是一个多维的过程，需要一个整体的方法 去关心。不幸的是，在现实世界中，药物治疗往往是患者唯一可用的治疗方法。 正念被定义为一种定向的、灵活的认知过程，允许一个人观察 思想和情绪，而不是对它们作出反应。适用于慢性疼痛、正念 寻求将疼痛的感觉体验与认知解释和情感反应脱钩-a 鉴于痛感和认知之间的密切联系，晚期癌症疼痛的理想策略- 情感反应(例如，对癌症进展和死亡的恐惧)。正念已被证明对 来自各种非癌症诊断的慢性疼痛，但对晚期癌症疼痛的正念研究是 缺乏。传统的正念计划，包括8周的长时间小组训练，每天 实践，是不切实际的，对大多数晚期癌症患者来说是无法获得的。此外，现有的计划是 不适应这些人群的身体限制，通常是强烈的情感和生存痛苦，也不 它们支持在家中成功应对癌症疼痛所需的自我管理的其他重要方面。 这项建议的目的是开发、完善和试点CHAMP(正念-癌症健康应用程序- 基于疼痛治疗)，这是一款新的智能手机应用程序，可提供针对 晚期癌症疼痛患者的需求。为了补充正念练习，冠军将整合 多媒体癌症疼痛心理教育和药物支持，最大限度地提高患者的应对和自我保护能力 管理。这个项目之所以可行，是因为团队能够利用正念内容、多媒体 癌症疼痛心理教育，以及现有两个mHealth项目(R21 NR017745和 R00 MD010468)。在目标1a中，研究团队将开发和规划CHAMP，涉及目标患者 用于多个级别的审查和修订的人员。在目标1b中，将在#年进行一次小型预试(N=5) 为了在试点研究之前完善这款应用程序。在AIM 2中，20名持续性疼痛患者来自各种晚期 一家主要学术癌症中心的实体恶性肿瘤患者将被分配使用CHAMP 8周。发现 将阐明数据收集的可行性，允许探索有意义的趋势，并使设计 一项未来的随机试验，以测试CHAMP改善晚期癌症患者疼痛和生活质量的能力。 这个项目的总结果将是一种量身定做的正念干预--如果被证明有效的话--有很好的 扩大规模并向患有不成比例疾病的人群提供心身治疗的潜力 慢性疼痛，目前获得有效的非药物治疗的机会极其有限。

PROJECT SUMMARY Pain affects approximately two thirds of patients with advanced, incurable cancer, with rates approaching 90% near the end-of-life. Advanced cancer pain can be notoriously severe, degrading patients' emotional, social, and functional wellbeing. Advanced cancer pain is a multidimensional process that requires a holistic approach to care. Unfortunately, in real world settings pharmacotherapy is often the only treatment available to patients. Mindfulness has been defined as a directed, flexible cognitive process that allows a person to observe thoughts and emotions in the moment, as opposed to reacting to them. Applied to chronic pain, mindfulness seeks to decouple the sensory experience of pain from cognitive interpretations and emotional reactions – a ideal strategy for advanced cancer pain given the close connection between pain sensations and cognitive- affective responses (e.g. fears of cancer progression and death). Mindfulness has been proven effective for chronic pain from a variety of non-cancer diagnoses, but studies of mindfulness for advanced cancer pain are lacking. Traditional mindfulness programs, which involve 8 weeks of lengthy group-based trainings with daily practice, are impractical and inaccessible to most advanced cancer patients. Moreover, existing programs are not adapted to this populations' physical limitations, often intense emotional and existential distress, nor do they support other vital aspects of self-management required to successfully cope with cancer pain at home. The object of this proposal is to develop, refine and pilot CHAMP (Cancer Health Application for Mindfulness- based Pain treatment), a novel smartphone application to deliver mobile mindfulness training tailored to the needs of patients with advanced cancer pain. To complement mindfulness practice, CHAMP will integrate multimedia cancer pain psychoeducation and medication support, maximizing patients' ability to cope and self- manage. This project is made feasible by the team's ability to leverage mindfulness content, multi-media cancer pain psychoeducation, and design features from two existing mHealth projects (R21 NR017745, and R00 MD010468). In Aim 1a, the study team will develop and program CHAMP, involving the target patient population for multiple levels of review and revision. In Aim 1b, a small pre-pilot will be conducted (N=5) in order to refine the app prior a pilot study. In Aim 2, 20 patients with persistent pain from a variety of advanced solid malignancies at a major academic cancer center will be assigned to use CHAMP for 8 weeks. Findings will illuminate the feasibility of data collection, allow exploration of meaningful trends, and enable the design of a future randomized trial to test the ability of CHAMP to improve pain and QOL for advanced cancer patients. The sum result of this project will be a tailored, mindfulness intervention which - if proven effective - has great potential to scale and make mind-body treatment available to a population that suffers disproportionately from chronic pain and currently has extremely limited access to effective, non-pharmacologic management.