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(申请人提供)：接受放射治疗(XRT)的头颈部癌症(HNC)患者即使在接受明确治疗后仍会出现严重的副作用，如流涎异常减少、吞咽困难和味道改变。为了控制副作用并将不适降至最低，医生开出了加强自我护理的方案，但依从性很差。伴侣(配偶/重要的其他人)可以在支持坚持方面发挥关键作用，但往往缺乏知识，经历高患难率，并表现出沟通不良(例如，关键或控制)，这可能会干扰患者的自我护理。我们开发了以家庭为基础的夫妻技能培训(CST)干预，教授：1)自我管理技能，以控制/防止副作用；2)沟通技能，以促进护理和支持的协调；3)战略，以改善社区应对和对团队合作能力的信心。其目标是降低医疗保健利用率，改善患者和伴侣的多个领域的生活质量。具体目标是：制定和评估科技委干预措施的内容和材料(目标1)，并评估其可行性和可接受性(目标2)。多学科团队将根据我们与HNC夫妇正在进行的工作(K07)来审查和评估我们已经开发的内容。一旦内容最终确定，将为患者和合作伙伴制定量身定做的手册，并通过两个重点小组进行评估(目标1)。然后，在患者开始XRT(基线)之前，将招募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(UMC)。我们预计，我们接触的大多数夫妇(60%)将同意参加，CST将被很好地接受(目标2)。虽然这项试验不是为了测试群体差异，但我们预计：1)与接受UMC~的患者相比，接受CST的患者在XRT期间的医疗利用率更低(例如，计划外门诊就诊更少)，在1、3和6个月的随访中，更好的身体生活质量(例如，更少的体重减轻、症状负担)；2)与接受UMC~的患者相比，接受CST的患者和伴侣在随访时将体验到更好的关系功能和更少的情绪困扰(例如，抑郁和焦虑症状)。所获得的知识将用于改进CST，并为更大规模的试验收集有关效应大小和变异的数据。创新：CST采取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生活质量的多个领域。这也是HNC中第一个积极让夫妻双方成员参与的计划，以解决家庭环境中自我管理的障碍。最后，这项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：以家庭为基础的分娩将加强未来对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、减少昂贵的住院和治疗中断以及改善患者和伴侣生活质量的多个方面都有很大的希望。