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

描述(申请人提供)：持续性疼痛是接受造血干细胞移植(HSCT)的患者面临的主要挑战，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HSCT患者的疼痛管理策略，以补充现有的止痛方案。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发挥着重要作用。我们发现，HSCT患者对自己控制疼痛的能力缺乏信心(即自我效能)，并且高度使用适应性不良的应对策略(即疼痛灾害化)，则会经历更多的疼痛和残疾。改善患者认知和行为疼痛应对策略的心理社会干预可能使HSCT患者受益。治疗方案，特别是疼痛应对技能训练(PCST)，已被开发用于减轻疼痛和改善持续性疼痛患者的生活质量。然而，持续疼痛的HSCT患者面临着许多独特的挑战，当应用PCST方案时必须考虑这些挑战。我们建议为持续疼痛的HSCT患者开发和测试移动健康疼痛应对技能(MPCST)协议，以应对HSCT患者从医院护理过渡到家庭环境的挑战。这项研究的第一个目的是使用迭代开发模型来设计针对HSCT患者的mPCST干预方案，其目标是提高疼痛控制的自我效能并减少疼痛灾难。我们将使用患者和HSCT提供者的焦点小组来指导开发，以及对有疼痛的HSCT患者进行用户测试。这项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、可接受性和参与度。第三个目的是获得与标准护理控制条件相比，开发的mPCST方案在减少疼痛、疼痛残疾、身体残疾以及遵守受疼痛影响的移植后生活方式建议方面的效果大小的估计。将制定的mPCST协议的拟议创新特征包括：PCST和HSCT专家以及HSCT疼痛患者的广泛投入；出院前的初始会议，随后的会议通过视频会议在家中举行；纳入减少疼痛对遵守移植后重要生活方式建议的影响的战略；具有后续量身定制反馈的实时每日评估系统。如果 开发的mPCST方案证明了影响疼痛和其他生活质量指数的可行性、可接受性、参与度和有希望的效果大小，将寻求更大的NIH拨款，以在更大的患者样本中检查该方案，对照积极治疗测试该方案，并调查更广泛的结果(例如，药物依从性)。这种mPCST方案也可以在面临类似挑战(例如，居住距离医疗中心较远、旅行限制)的其他疼痛患者群体中进行检验。

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).