Building Resiliency Among Caregivers of Curvivors and Metavivors: A Pilot randomized Trial

建立幸存者和元幸存者的照顾者的复原力：一项随机试点试验

• 批准号: 10509455
• 负责人: Areej El-Jawahri
• 金额: $ 43.2万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-19 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10509455
• 关键词: Address; Adherence; Affect; Aftercare; Age; Anxiety; Cancer Center; Cancer Survivor; Cancer Survivorship; Caregivers; Caring; Chronic; Chronic stress; Climacteric; Coping Skills; Diagnosis; Disease; Distress; Early Diagnosis; Emergency department visit; Enrollment; Ensure; Face; Family member; Fatigue; Feeling; Financial Hardship; Friends; Fright; General Hospitals; Growth; Hair; Health; Healthcare; Healthcare Systems; Hospitalization; Hydrocortisone; Intake; Intervention; Intervention Studies; Interview; Late Effects; Malignant Neoplasms; Massachusetts; Medical; Mental Health Services; Morbidity - disease rate; Outcome; Outcomes Research; Overutilization of Health Services; Pain; Patients; Physiological; Play; Population; Posttraumatic growth; Primary Health Care; Quality of Care; Quality of life; Randomized; Relaxation Therapy; Reporting; Role; Screening for cancer; Services; Social Functioning; Source; Stress; Support Groups; Surveys; Survivors; Testing; Treatment-related toxicity; Visit; Work; acceptability and feasibility; biobehavior; body-mind; cancer recurrence; caregiver interventions; caregiving; cognitive function; eHealth; effectiveness implementation trial; eligible participant; emotional distress; end of life; evidence base; experience; follow-up; group intervention; health care service; health care service utilization; improved; loved ones; multidisciplinary; neglect; programs; psychologic; randomized trial; resilience; response; satisfaction; secondary outcome; skills; stress management; stress resilience; stressor; treatment as usual; virtual; virtual intervention

There is a large and growing population of caregivers (partner/family member/friend) for cancer survivors who have completed curative intent therapy (“curvivors”) and for those who live for many years with metastatic disease (“metavivors”). The emotional distress that caregivers experience is universal, irrespective of their loved one’s diagnosis, stage, treatment, or illness trajectory. Caregivers of both curvivors and metavivors face similar ongoing stressors (e.g., such as fear of cancer recurrence/progression, treatment toxicities and late effects, and difficulty adapting to life changes after cancer) and struggle with elevated distress. There is increasing recognition of reciprocal dynamics between caregiver and survivor distress, underscoring the importance of addressing the psychological, physical, and healthcare utilization needs of both in order to improve health outcomes. Caregivers play a critical role to ensure that survivors adhere to recommended follow-up care as well as attend to their own healthcare needs. While the needs of cancer survivors and their caregivers are well described, there are no interventions specifically focusing on the needs of caregivers of curvivors and metavivors; interventions have focused on caregiving at the end of life and not the chronic, ongoing stress of post-treatment transitions and living with cancer. Furthermore, caregiver interventions have not focused on promoting resiliency skills as a strategy to enhance post-traumatic growth and caregivers’ capacity to manage chronic stress and distress. Our team has developed an evidence-based mind-body group resiliency intervention, the Stress Management and Resiliency Training-Relaxation Response Program (SMART-3RP) and has demonstrated its efficacy for improving resiliency and reducing distress in patients with chronic medical conditions and healthcare clinicians. We propose to conduct a pilot randomized trial of the SMART 3RP vs. enhanced usual care. The population is 48 caregivers and cancer survivor dyads at the Massachusetts General Hospital Cancer Center. We propose to intervene simultaneously, yet focus separately, on improving the resiliency of caregivers and survivors. We will determine the feasibility and acceptability of a SMART-3RP for cancer caregivers and survivors; determine the preliminary efficacy of the SMART-3RP for improving resiliency in caregivers and survivors; and explore effects of SMART-3RP on caregivers’ and survivors’ health care utilization. Our multidisciplinary team has extensive experience in conducting survivor and caregiver outcome research, developing and testing biobehavioral and e-Health interventions, and examining healthcare system utilization. If proven effective, this virtual intervention can be tested in an effectiveness-implementation trial to improve the experience and quality of care for millions of caregivers and cancer survivors.

为癌症幸存者提供照顾者(伴侣/家人/朋友)的人数很大，而且还在不断增长 已经完成了治疗意图治疗(“Curvivors”)和那些生活了多年的转移性肿瘤患者 疾病(“变食者”)。照顾者经历的情绪痛苦是普遍的，无论他们 所爱的人的诊断、阶段、治疗或疾病轨迹。Curvivors和Metavivors的照顾者面对 类似的持续应激源(例如，对癌症复发/进展的恐惧、治疗毒性和晚期 癌症影响和难以适应癌症后的生活变化)，并与更高的痛苦作斗争。的确有 越来越多的人认识到照顾者和幸存者之间的相互作用，强调了 满足两者的心理、身体和医疗保健利用需求的重要性 改善健康状况。护理员在确保幸存者遵守建议的 后续护理以及照顾自己的医疗保健需求。虽然癌症幸存者和他们的需求 照顾者被很好地描述，没有专门关注照顾者需求的干预措施 康复者和变性者；干预措施侧重于生命末期的护理，而不是慢性病患者， 持续的治疗后过渡和癌症生活的压力。此外，护理者的干预措施 没有将促进复原力技能作为促进创伤后成长和照顾者的战略的重点 管理长期压力和痛苦的能力。我们的团队已经开发了一个基于证据的心身小组 弹性干预、压力管理和弹性训练-放松反应计划 (SMART-3RP)，并已证明其在提高恢复力和减少患者痛苦方面的疗效 慢性疾病和保健临床医生。我们建议进行一项试点随机试验， 智能3RP与增强的日常护理。人口中有48名照顾者和癌症幸存者二人 马萨诸塞州总医院癌症中心。我们建议同时进行干预，但重点是 另外，关于提高照顾者和幸存者的复原力。我们将确定可行性和 SMART-3RP对癌症护理人员和幸存者的可接受性；确定该药物的初步疗效 SMART-3RP用于提高照顾者和幸存者的复原力；并探讨SMART-3RP对 照顾者和幸存者的卫生保健利用情况。我们的多学科团队在以下方面拥有丰富的经验 开展幸存者和照顾者成果研究，开发和测试生物行为和电子健康 干预措施，并检查医疗保健系统的利用率。如果被证明有效，这种虚拟干预可以 在有效性实施试验中进行了测试，以改善数百万人的护理体验和质量 照顾者和癌症幸存者。