Home-Based Tablet Computer Pain Coping Skills Following Stem Cell Transplant

描述（由申请人提供）：持续性疼痛是接受造血干细胞移植（HSCT）患者的主要挑战，与更多的疲劳、更多的身体残疾、更差的生活质量和更差的医疗依从性有关。有必要研究管理HSCT患者疼痛的策略，以补充现有的镇痛方案。强有力的证据表明，认知和行为因素在HSCT患者控制疼痛的能力中起着重要作用。我们发现，HSCT患者对自己控制疼痛的能力缺乏自信（即自我效能感），并且高度使用不适应的应对策略（即疼痛灾难化），会增加疼痛和残疾。改变患者认知和行为疼痛应对策略的社会心理干预可能对HSCT患者有益。方案，特别是疼痛应对技能训练（PCST），已经开发出减轻疼痛和改善生活质量的患者持续疼痛。然而，持续性疼痛的HSCT患者在应用PCST方案时必须考虑到许多独特的挑战。我们建议为持续性疼痛的HSCT患者开发和测试一种移动健康疼痛应对技能（mPCST）方案，以应对疼痛的HSCT患者从医院护理过渡到家庭环境的挑战。本研究的第一个目的是使用迭代开发模型设计一种针对HSCT患者的mPCST干预方案，以提高疼痛控制的自我效能和减少疼痛灾难化。我们将利用患者和HSCT提供者的焦点小组来指导开发，同时对有疼痛的HSCT患者进行用户测试。本研究的第二个目的是使用一项小型随机对照试验来检查开发的mPCST方案的可行性、可接受性和参与性。第三个目的是获得与标准护理对照条件相比，开发的mPCST方案在减轻疼痛、疼痛残疾、身体残疾和坚持受疼痛影响的移植后生活方式建议方面的效应大小的估计。拟定的mPCST方案的创新特点包括：广泛听取PCST和HSCT专家以及疼痛的HSCT患者的意见；出院前的首次会议，随后的会议在家中通过视频会议进行；纳入减少疼痛对移植后关键生活方式建议依从性影响的策略；一个实时的每日评估系统，随后量身定制的反馈。如果

DESCRIPTION (provided by applicant): Persistent pain is a major challenge for patients who undergo hematopoietic stem cell transplant (HSCT) and is related to more fatigue, more physical disability, poorer quality of life, and poorer medical adherence. There is a need to examine strategies for managing pain in HSCT patients that can complement existing analgesic regimens. Strong evidence suggests that cognitive and behavioral factors play an important role in HSCT patients' ability to manage their pain. We have found that HSCT patients having low levels of confidence (i.e., self-efficacy) in their ability to control pain and high use of maladapive coping strategies (i.e., pain catastrophizing) experience increased pain and disability. A psychosocial intervention that modifies patients' cognitive and behavioral pain coping strategies may benefit HSCT patients. Protocols, particularly Pain Coping Skills Training (PCST), have been developed for reducing pain and improving quality of life in patients with persistent pain. However, HSCT patients with persistent pain face a number of unique challenges that must be considered when applying a PCST protocol. We propose to develop and test a Mobile Health Pain Coping Skills (mPCST) protocol for HSCT patients with persistent pain to meet the challenges of HSCT patients with pain as they transition from hospital based care to their home environment. The first aim of this study is to use an iterative development model to design a mPCST intervention protocol for HSCT patients that targets increasing self-efficacy for pain control and decreasing pain catastrophizing. We will use focus groups with patients and HSCT providers to guide development along with user testing with HSCT patients having pain. The second aim of this study is to use a small randomized controlled trial to examine the feasibility, acceptability, and engagement in the developed mPCST protocol. The third aim is to obtain an estimate of the effect size of the developed mPCST protocol on decreased pain, pain disability, physical disability, and adherence to post-transplant lifestyle recommendations impacted by pain when compared to a standard care control condition. Proposed innovative features of the mPCST protocol that will be developed include: extensive input from PCST and HSCT experts and HSCT patients with pain; an initial session prior to discharge with subsequent sessions occurring at home via video-conferencing; incorporation of strategies to decrease the impact of pain on adherence to critical post-transplant lifestyle recommendations; a real-time daily assessment system with subsequent tailored feedback. If the developed mPCST protocol demonstrates feasibility, acceptability, engagement, and promising effect sizes to influence pain and other indices of quality of life, a larger NIH grant wll be sought to examine this protocol in a larger sample of patients, test the protocol against an active treatment, and investigate a broader array of outcomes (e.g., medication adherence). This mPCST protocol could also be examined in other patient populations with pain facing similar challenges (e.g., live far from medical center, travel limitations).