Adherence to the HCT Medical Regimen: Influence of Cancer Patient-Cargiver Dyads

描述（由申请人提供）：Donna Posluszny博士的职业目标是开发一个独立的研究项目，专注于设计和评估新的行为和社会心理干预措施，以提高癌症患者-家庭护理人员对复杂医疗方案的坚持能力，并改善患者的身体健康结果。K23奖将使医学助理教授兼临床心理学家Posluszny博士能够通过提供癌症医疗方案研究方面的培训，朝着这一目标迈出必要的第一步；癌症患者依从性研究领域的行为与心理干预发展以及指导和分析纵向和介入性临床研究的方法与患者和家庭护理人员的关系。具体来说，五年培训计划包括：(1)正式课程；(2)定期接受导师和顾问的指导；（三）参加研讨会、讲习班和全国性会议；(4)指导研究；(5)临床实践。Posluszny博士的临床培训，她的指导团队的专业知识，以及匹兹堡大学医学院和匹兹堡大学癌症研究所的研究环境的结合，将促进拟议的培训计划和研究的成功实施。该研究计划致力于实施一个独立的项目，以评估患者和家庭护理人员在HCT后的前100天内对复杂的多组分造血干细胞移植（HCT）的依从性，并开发和试点以问题解决治疗原则为基础的以患者-护理人员为中心的双重心理教育干预，以增强对HCT后医疗方案的依从性。具体目的是：(1)调查患者和护理人员在出院后如何划分与遵守多组分hct后医疗方案相关的责任；(2)确定不遵守hct后医疗方案的比率、关键风险因素和患者健康结果；(3)开发并初步评估了一项以患者-护理者二元对立为中心的试点心理教育干预措施，旨在减少对hct后医疗方案的不依从性。该应用程序解决了国家癌症研究所继续致力于发展倡议，以了解家庭在癌症经历中的作用并改善患者的健康结果，并且在其对依从性的双重关注方面是独一无二的。总的来说，本研究的结果将促进对HCT后医疗方案依从性的适应性和非适应性双重方法的识别，并为心理教育干预提供基础和初步数据，以提高HCT患者及其家庭照顾者的依从性，从而改善患者的健康结果。

DESCRIPTION (provided by applicant): Dr. Donna Posluszny's career goal is to develop an independent research program focused on designing and evaluating novel behavioral and psychosocial interventions to enhance cancer patient-family caregiver dyads' ability to adhere to complex medical regimens and improve patient physical health outcomes. The K23 award will enable Dr. Posluszny, who is an Assistant Professor of Medicine and a clinical psychologist, to take the necessary first steps towards this goal by providing training in medical regimen research in cancer; behavioral and psychosocial intervention development in the field of adherence research in cancer; and methodologies for conducting and analyzing longitudinal and interventional clinical research with patient and family caregiver dyads. Specifically, the five-yer training plan includes (1) formal coursework; (2) regular mentoring from mentors and consultants; (3) participation in seminars, workshops, and national conferences; (4) mentored research; and (5) clinical practice. The combination of Dr. Posluszny's clinical training, the expertise of her mentoring team, and the research environment of the University of Pittsburgh School of Medicine and University of Pittsburgh Cancer Institute will facilitate the successful implementation of the proposed training plan and research study. The research plan is devoted to the implementation of an independent project to evaluate patient and family caregiver adherence to the complex, multicomponent post- hematopoietic stem cell transplantation (HCT) during the first 100 days post HCT and the development and piloting of a patient-caregiver dyad-focused psychoeducational intervention, grounded in the principles of Problem-Solving Therapy, to enhance adherence to the post-HCT medical regimen. Specific aims are (1) investigation of how patients and caregivers divide the responsibilities associated with adherence to the multicomponent post-HCT medical regimen post-hospital discharge; (2) determination of rates of, key risk factors for, and patient health outcomes associated with nonadherence to the post-HCT medical regimen; and (3) development and preliminary evaluation of a pilot patient-caregiver dyad-focused psychoeducational intervention designed to decrease nonadherence to the post-HCT medical regimen. This application addresses the National Cancer Institute's continuing commitment to developing initiatives to understand the role of family in the cancer experience and improve patient health outcomes, and is unique in its dyadic focus on adherence. Collectively, the outcomes of this study will foster the identification of both adaptive and nonadaptive dyadic approaches to adherence to the post-HCT medical regimen and provide the groundwork and preliminary data for a psychoeducational intervention to improve adherence for HCT patients and their family caregivers, and thereby improve patient health outcomes.