The Promoting Resilience in Stress Management (PRISM) Intervention: a multi-site randomized controlled trial for Adolescents and Young Adults with advanced cancer

项目概要 青少年和年轻人 (AYAs) 中的癌症特别困难，因为与年龄相关 身份、人际关系和职业的发展挑战可能会增加癌症的负担。比较 与其他年龄组相比，AYA 的社会心理结果较差。在患有晚期癌症的 AYA 中也是如此 许多人错过了表达希望、担忧和临终偏好的机会，这对患者来说 和家长的苦恼。改善这些体验的一个潜在障碍可能是 AYA 很少有 开发应对逆境和表达需求所需的个人资源的机会。我们 之前描述过针对 AYA 的“促进压力管理恢复力”(PRISM) 干预 患有癌症。这种手动的简短干预通过 4 个 30-60 分钟的一对一课程进行，然后 通过家庭会议。它针对的是压力管理和正念、目标设定、积极重构、 和意义创造。所有这些技能都与改善其他人群的患者福祉相关， 最近在新诊断出癌症的 AYA 中进行的一项随机对照试验的结果表明 PRISM 与提高复原力、减少心理困扰和提高健康水平有关。 相关生活质量 (HRQOL)。该应用程序建议以我们之前的经验为基础，并填补三个关键问题 知识差距：(1) PRISM 对患有晚期（而非早期）癌症的 AYA 的影响； (2) AYA-PRISM 参与与家长结果之间的关联； (3) PRISM 之间的关联 技能和患者参与临床决策。该资助机会旨在测试 AYA 特定的 旨在积极影响 HRQOL 的姑息治疗干预措施。因此，我们提出了多站点随机 在 N=144 名 AYA（n=72 PRISM，n=72 常规护理；年龄 12-21 岁）中进行的对照试验以及主要试验 入组后 3 个月患者报告的 HRQOL 结果。次要结果将包括患者- 和家长报告的焦虑和抑郁，以及家庭“姑息治疗激活”（代表 AYA 的希望和担忧、参与护理目标对话以及正式姑息治疗的利用 和心理社会服务）。我们假设接受 PRISM 的 AYA 及其父母的报告会更高 与接受常规护理的患者相比，HRQOL、焦虑/抑郁程度较低，激活程度较高。 该应用程序提供了扩展有关严格方法论的知识体系的机会 以及针对患有晚期癌症和癌症的 AYA 的基于证据的姑息治疗干预措施和护理标准 他们的家人。最终，这项研究有可能减轻这些弱势群体的癌症负担 人口。

PROJECT SUMMARY Cancer among Adolescents and Young Adults (AYAs) is particularly difficult because age-related developmental challenges of identity, relationships, and vocation may add to the burden of cancer. Compared to other age-groups, AYAs have poorer psychosocial outcomes. Among AYAs with advanced cancer, too many miss opportunities to express their hopes, worries and end-of-life preferences, translating to both patient and parent distress. A potential barrier to improving these experiences may be that AYAs have few opportunities to develop the personal resources needed to handle adversity and articulate their needs. We have previously described the “Promoting Resilience in Stress Management” (PRISM) intervention for AYAs with cancer. This manualized, brief intervention is delivered in 4, 30-60 minute, one-on-one sessions, followed by a family meeting. It targets skills in stress-management and mindfulness, goal-setting, positive reframing, and meaning-making. All of these skills are associated with improved patient well-being in other populations, and findings from a recent pilot randomized controlled trial among AYAs with newly diagnosed cancer suggest PRISM is associated with improved perceptions of resilience, lower psychological distress, and higher health- related quality of life (HRQOL). This application proposes to build on our prior experience and fill three critical knowledge gaps: (1) PRISM’s impact among AYAs with advanced (as opposed to early stage) cancer; (2) Associations between AYA-PRISM participation and parent outcomes; and, (3) Associations between PRISM skills and patient engagement in clinical decision-making. This funding opportunity seeks to test AYA-specific palliative care interventions designed to positively impact HRQOL. Thus, we propose a multi-site randomized controlled trial among N=144 AYAs (n=72 PRISM, n=72 Usual Care; ages 12-21) with the primary trial outcome of patient-reported HRQOL 3 months following enrollment. Secondary outcomes will include patient- and parent-reported anxiety and depression, and family “palliative care activation” (advocacy on behalf of AYA’s hopes and worries, engagement in goals-of-care conversations, and utilization of formal palliative care and psychosocial services). We hypothesize that AYAs who receive PRISM and their parents will report higher HRQOL, lower anxiety/depression, and higher activation when compared to those who receive usual care. This application offers an opportunity to expand the body of knowledge regarding methodologically rigorous and evidence-based palliative care interventions and standards of care for AYAs with advanced cancer and their families. Ultimately, this research has the potential to reduce the burden of cancer in these vulnerable populations.