Improving Self-management in Head and Neck Cancer

改善头颈癌的自我管理

• 批准号: 8752355
• 负责人: Hoda J Badr
• 金额: $ 22.12万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8752355
• 关键词: Acute; Address; Adherence; Adverse effects; Affect; Anxiety; Appointment; Behavior; Behavioral; Body Weight decreased; Cancer Patient; Caring; Clinic; Clinic Visits; Communication; Counseling; Couples; Data; Deglutition; Dental; Distress; Education; Educational Intervention; Educational Materials; Educational process of instructing; Emotional; Focus Groups; Future; Goals; Head and Neck Cancer; Health; Home environment; Hospitalization; Interruption; Intervention; Joints; Knowledge; Lead; Life; Literature; Malnutrition; Manuals; Medical; Mental Depression; Monitor; Nature; Nutritional; Outcome; Patient Care; Patients; Personal Satisfaction; Play; Problem Solving; Procedures; Process; Protocols documentation; Psychiatric Social Work; Quality of life; Radiation; Randomized; Recruitment Activity; Resources; Role; Self Care; Self Management; Services; Source; Spouses; Supportive care; Symptoms; Target Populations; Taste Perception; Telephone; Testing; Training; Treatment outcome; Variant; Work; base; cancer therapy; caregiving; coping; design; emotional distress; experience; head and neck cancer patient; health care service utilization; improved; innovation; member; multidisciplinary; oral mucositis; outreach; prevent; programs; psychologic; psychosocial; public health relevance; response; saliva secretion; satisfaction; skills; skills training; social

DESCRIPTION (provided by applicant): Patients treated with radiation (XRT) for head and neck cancers (HNCs) experience significant side effects such as abnormally reduced salivation, difficulty swallowing, and taste changes even after they have been definitively treated. To control side effects and minimize discomfort, intensive self-care protocols are prescribed, but adherence is poor. Partners (spouses/significant others) can play a critical role in supporting adherence, but often lack knowledge, experience high rates of distress, and display poor communication (e.g., critical or controlling), that can interfere with patient self-care. We have developed a home-based couples skills-training (CST) intervention that teaches: 1) self-management skills to control/prevent side-effects~ 2) communication skills to facilitate coordination of care and support~ and 3) strategies to improve communal coping and confidence in the ability to work as a team. The goal is to reduce healthcare utilization and improve multiple domains of patient and partner QOL. Specific aims are to: develop and evaluate the content and materials of the CST intervention (AIM 1) and evaluate its feasibility and acceptability (AIM 2). The multidisciplinary team will review and evaluate the content we have already developed based on our ongoing work with HNC couples (K07). Once content is finalized, tailored manuals will be developed for patients and partners and evaluated through two focus groups (AIM 1). Sixty couples will then be recruited before the patient starts XRT (baseline) and randomly assigned to the CST condition (tailored manuals + 6 telephone counseling sessions), or usual medical care (UMC). We expect that most couples (> 60%) we approach will agree to participate and that CST will be well-accepted (AIM 2). Although this pilot is not designed to test for group differences, we expect: 1) patients receiving CST will have less healthcare utilization during XRT (e.g., fewer unplanned clinic visits), and better physical QOL (e.g., less weight loss, symptom burden) at the 1, 3, and 6 month follow-ups than patients receiving UMC~ and, 2) patients and partners receiving CST will experience better relationship functioning and less emotional distress (e.g., depression and anxiety symptoms) at the follow-ups than those receiving UMC. Knowledge gained will be used to refine CST and to collect data on effect sizes and variation for a larger trial. Innovation: CST takes a multiple-behavioral approach to addressing and preventing HNC treatment side effects and, in the process, seeks to improve multiple domains of QOL. It is also the first program in HNC that actively involves both members of the couple to address barriers in the home environment in which self-management occurs. Finally, this study conceptualizes the couple relationship as a resource and leverages that resource to improve patient care and outcomes. Impact: Home-based delivery will enhance future dissemination and outreach to the target population. Overall, CST holds great promise for improving patient self-management behaviors, reducing costly hospitalizations and treatment interruptions, and improving multiple aspects of patient and partner QOL.

描述（由申请人提供）：接受放射（XRT）治疗头颈癌（HNC）的患者即使在接受明确治疗后也会出现显著的副作用，如唾液分泌异常减少、吞咽困难和味觉变化。为了控制副作用和尽量减少不适，规定了强化自我护理方案，但依从性很差。伴侣（配偶/重要的其他人）可以在支持依从性方面发挥关键作用，但往往缺乏知识，经历高比例的痛苦，并表现出沟通不畅（例如，关键或控制），这可能会干扰患者的自我护理。我们开发了一种以家庭为基础的夫妻技能培训（CST）干预措施，教授：1）自我管理技能，以控制/预防副作用2）沟通技巧，以促进护理和支持的协调3）策略，以提高社区应对能力和对团队工作能力的信心。其目标是减少医疗保健利用率，提高患者和伴侣QOL的多个领域。具体目标是：开发和评估CST干预的内容和材料（AIM 1），并评估其可行性和可接受性（AIM 2）。多学科团队将审查和评估我们已经开发的内容，基于我们正在进行的HNC夫妇（K 07）的工作。一旦内容最终确定，将为患者和合作伙伴开发量身定制的手册，并通过两个焦点小组（AIM 1）进行评估。然后在患者开始XRT（基线）之前招募60对夫妇，并随机分配到CST条件（定制手册+ 6次电话咨询会议）或常规医疗护理（UMC）。我们预计，我们接触的大多数夫妇（> 60%）将同意参与，CST将被广泛接受（AIM 2）。 尽管该试点并非旨在测试组间差异，但我们预计：1）接受CST的患者在XRT期间的医疗保健利用率将减少（例如，更少的计划外门诊访视）和更好的身体QOL（例如，在1、3和6个月随访时体重减轻、症状负担更少），2）接受CST的患者和伴侣将经历更好的关系功能和更少的情绪困扰（例如，抑郁症和焦虑症状）在随访中比那些接受UMC。所获得的知识将用于完善CST，并为更大规模的试验收集有关效应量和变异的数据。创新：CST采用多行为方法来解决和预防HNC治疗副作用，并在此过程中寻求改善QOL的多个领域。这也是HNC的第一个方案，积极参与夫妇双方的成员，以解决在家庭环境中的自我管理发生的障碍。最后，本研究将夫妻关系概念化为一种资源，并利用这种资源来改善患者的护理和结果。影响：在家中提供服务将加强今后向目标人口的传播和外联。总体而言，CST在改善患者自我管理行为、减少昂贵的住院治疗和治疗中断以及改善患者和伴侣QOL的多个方面方面具有很大的前景。