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）：接受辐射治疗的患者（XRT）针对头颈癌（HNC）（HNC）经历了显着副作用，例如垂涎三尺，吞咽困难和味觉变化，即使已确定治疗。为了控制副作用并最大程度地减少不适感，规定了密集的自我保健方案，但依从性很差。合作伙伴（配偶/其他重要的人）可以在支持依从性，但通常缺乏知识，经历高度的遇到率并表现出较差的沟通（例如，关键或控制）中发挥关键作用，这可能会干扰患者的自我保健。我们已经开发了一种家庭夫妻技能培训（CST）干预措施：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〜和3）提高社区应对和对团队工作能力的信心的策略。目的是减少医疗保健利用并改善患者和伴侣QOL的多个领域。具体目的是：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）。多学科团队将根据我们与HNC夫妇的持续工作（K07）进行审查和评估我们已经开发的内容。一旦完成内容，将为患者和伴侣制定量身定制的手册，并通过两个焦点小组进行评估（AIM 1）。然后将在患者开始XRT（基线）并随机分配到CST状态（量身定制的手册 + 6个电话咨询会议）或通常的医疗服务（UMC）之前招募60对夫妇。我们希望大多数夫妻（> 60％）我们将同意参加，并且CST将得到很好的接受（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 （例如，抑郁症和焦虑症状）在随访中，比接受UMC的抑郁症和焦虑症。获得的知识将用于完善CST，并收集有关效果大小和更大试验变化的数据。创新：CST采取多种行为方法来解决和防止HNC治疗副作用，并在此过程中试图改善QOL的多个领域。这也是HNC中的第一个计划，该计划积极涉及这对夫妇的两个成员解决自我管理的家庭环境中的障碍。最后，这项研究概念化了夫妻关系作为一种资源，并利用该资源来改善患者的护理和结果。影响：基于家庭的交付将增强未来的传播和向目标人群推广。总体而言，CST对改善患者的自我管理行为，减少昂贵的住院和治疗中断以及改善患者和伴侣QOL的多个方面有很大的希望。