Improving Self-management in Head and Neck Cancer

改善头颈癌的自我管理

• 批准号: 9337152
• 负责人: Hoda J Badr
• 金额: $ 8.17万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 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 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9337152
• 关键词: Improving; Self; management; Head; Neck

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（HNCs）的患者即使在接受明确治疗后也会出现明显的副作用，如异常的唾液分泌减少、吞咽困难和味觉变化。为了控制副作用和减少不适，制定了严格的自我护理方案，但依从性很差。伴侣（配偶/重要他人）可以在支持依从性方面发挥关键作用，但往往缺乏知识，经历高痛苦率，表现出不良的沟通（例如，批评或控制），这可能会干扰患者的自我照顾。我们已经开发了一种以家庭为基础的夫妻技能培训（CST）干预，它教授：1)控制/预防副作用的自我管理技能；2)促进护理和支持协调的沟通技巧；3)提高集体应对能力和团队合作能力的信心的策略。目标是降低医疗保健利用率，并改善患者和合作伙伴生活质量的多个领域。具体目标是：制定和评估CST干预的内容和材料（目标1），评估其可行性和可接受性（目标2）。多学科小组将审查和评估我们根据正在进行的与HNC夫妇的工作已经开发的内容（K07）。一旦最终确定内容，将为患者和合作伙伴制定量身定制的手册，并通过两个焦点小组进行评估（AIM 1）。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（量身定制的手册+ 6个电话咨询会议）或常规医疗护理（UMC）。我们预计我们接触的大多数夫妇（约60%）将同意参与，CST将被广泛接受（AIM 2）。虽然这个试点不是为了测试群体差异而设计的，但我们预计：1)接受CST的患者在XRT期间的医疗保健利用率较低（例如，计划外门诊就诊较少），在1、3和6个月的随访中，身体生活质量较好（例如，体重减轻，症状负担减轻）；2)接受CST的患者和伴侣在随访中比接受UMC的患者有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效应大小和变化的数据。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生活质量的多个领域。这也是HNC第一个让夫妻双方积极参与的项目，以解决家庭环境中出现的自我管理障碍。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：以家庭为基础的服务将加强今后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、减少昂贵的住院费用和治疗中断以及改善患者和合作伙伴生活质量的多个方面具有很大的前景。