Telephone Symptom Management for Advanced Lung Cancer Patients and Caregivers

晚期肺癌患者和护理人员的电话症状管理

• 批准号: 8881118
• 负责人: Catherine E Mosher
• 金额: $ 13.64万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-05 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8881118
• 关键词: Address; Advanced Malignant Neoplasm; Affect; Anxiety; Attention; Award; Behavioral; Behavioral Medicine; Cancer Control; Cancer Patient; Caregiver Burden; Caregivers; Chronic; Clinical; Cognitive; Cognitive Therapy; Communication; Control Groups; Couples; Data; Development Plans; Diagnosis; Diagnostic Neoplasm Staging; Disease; Distant; Distress; Dyspnea; Emotions; Ensure; Family Caregiver; Fatigue; Feedback; Funding; Health; Instruction; Intervention; Intervention Trial; Interview; K-Series Research Career Programs; Lead; Learning; Length; Lung; Malignant Neoplasms; Malignant neoplasm of lung; Mediating; Mediator of activation protein; Mental Depression; Mentors; Natural History; Outcome; Pain; Patient Care; Patients; Pattern; Phase; Population; Psychological adjustment; Psychosocial Assessment and Care; Quality of life; Randomized; Relative (related person); Relaxation; Reporting; Research; Research Methodology; Research Personnel; Resources; Self Efficacy; Severities; Spouses; Staging; Symptoms; Target Populations; Technology; Telephone; Testing; Thinking; Training; Travel; United States; Woman; anxiety symptoms; base; career development; caregiving; coping; depressive symptoms; evidence base; experience; functional status; improved; innovation; meetings; men; novel; post intervention; preference; primary outcome; programs; psychologic; psychosocial; public health relevance; secondary outcome; skills; social cognitive theory; symptom management; theories

DESCRIPTION (provided by applicant): Lung cancer is frequently advanced at diagnosis, and over 80% of lung cancer patients experience multiple symptoms, such as depression, anxiety, pain, fatigue, and breathlessness, which negatively impact their quality of life. Family caregivers of lung cancer patients also experience high rates of anxiety and depressive symptoms and poor quality-of-life outcomes. This application proposes a program of research and career training focused on improving patient-caregiver dyads' physical and psychological adjustment to lung cancer. The proposed research will further develop and test a novel, dyad-focused telephone symptom management (TSM) intervention with the potential to treat highly prevalent and disabling symptoms in advanced lung cancer patients and their caregivers. The intervention is a blend of evidence-based cognitive-behavioral and emotion- focused strategies that include instruction in relaxation, adaptive thinking and communication skills, and activity planning and pacing. While prior studies have primarily tested cognitive-behavioral interventions to improve patients' and couples' adjustment to early-stage cancer, TSM addresses advanced cancer patients' and caregivers' concerns and combines cognitive-behavioral and emotion-focused approaches. The proposed research includes two phases. In Phase 1, qualitative interviews will be conducted with advanced lung cancer patients and caregivers (N = 24 dyads) to ensure that the intervention is sensitive to the needs and preferences of the target population. The intervention will then be revised based on the qualitative findings. In Phase 2, advanced lung cancer patients who meet established clinical cutoffs for at least one of five symptoms (i.e., depressive symptoms, anxiety, pain, fatigue, or breathlessness) and their family caregivers (e.g., spouse, other relative) who meet clinical cutoffs for depressive symptoms or anxiety (N = 100 dyads) will be randomized to (1) five weekly phone sessions of TSM intervention tailored to patients' and caregivers' symptoms, or (2) five weekly phone sessions of an attention control condition that provides an overview of resources for psychosocial support and health information. Assessments will be administered at baseline and 2 and 6 weeks post-intervention. Brief symptom assessments will also be administered to patients and caregivers during each intervention or control session. Patient outcomes will include symptom control (i.e., depressive symptoms, anxiety, pain, fatigue, breathlessness, and overall symptom burden), functional status, quality of life, and quality of relationship with the caregiver. Caregiver outcomes will include depressive symptoms, anxiety, strain, quality of life, and quality of relationship with the patient. Patient and caregiver self- efficacy for symptom management also will be assessed as potential mediators of the effects of TSM on outcomes. The proposed research has the potential to provide valuable, new information that can aid in selecting strategies for helping advanced lung cancer patients and their family caregivers better manage symptoms. The career development plan includes training in the natural history and clinical aspects of lung cancer and theories and research methods for developing and evaluating technology-based interventions for cancer patient-caregiver dyads. Through a combination of mentored research, coursework, seminars, and directed learning experiences, the applicant will develop the necessary skills for building an independently funded program of research focused on improving patient-caregiver dyads' physical and psychological adjustment to cancer.

简介(申请人提供)：肺癌在确诊时往往是晚期的，超过80%的肺癌患者会出现多种症状，如抑郁、焦虑、疼痛、疲劳和呼吸困难，这些症状会对他们的生活质量产生负面影响。家庭照顾者 肺癌患者的焦虑和抑郁症状发生率也很高，生活质量也很差。本申请提出了一项研究和职业培训计划，重点是改善患者-照顾者双方对肺癌的生理和心理适应。这项拟议的研究将进一步开发和测试一种新型的、以双向为重点的电话症状管理(TSM)干预措施，有可能治疗晚期肺癌患者及其照顾者的高度流行和致残症状。这种干预融合了基于证据的认知行为和以情绪为重点的策略，包括放松、适应性思维和沟通技能的指导，以及活动计划和步调。虽然之前的研究主要是测试认知行为干预措施，以改善患者和夫妇对早期癌症的适应，但TSM解决了晚期癌症患者和照顾者的担忧，并结合了认知行为和以情感为重点的方法。拟议的研究包括两个阶段。在第一阶段，将对晚期肺癌患者和照顾者(N=24对)进行定性访谈，以确保干预措施对目标人群的需求和偏好敏感。然后，将根据定性结果修改干预措施。在第二阶段，符合五种症状(即抑郁症状、焦虑、疼痛、疲劳或呼吸困难)至少其中一种症状的晚期肺癌患者和其家庭照顾者(例如，配偶、其他亲属)因抑郁症状或焦虑(N=100对)而达到临床临界值的患者将被随机分配到(1)根据患者和照顾者的症状进行每周五次的TSM干预电话会议，或(2)每周五次电话会议的注意力控制条件，提供关于心理社会支持和健康信息的资源概述。评估将在基线以及干预后2周和6周进行。在每次干预或对照期间，还将对患者和照顾者进行简短的症状评估。患者的结果将包括症状控制(即抑郁症状、焦虑、疼痛、疲劳、呼吸困难和总体症状负担)、功能状态、生活质量和与照顾者的关系质量。照顾者的结果将包括抑郁症状、焦虑、紧张、生活质量和与 有耐心的。患者和照顾者在症状管理方面的自我效能也将被评估为TSM对结果影响的潜在中介。这项拟议的研究有可能提供有价值的新信息，有助于选择帮助晚期肺癌患者及其家人更好地管理症状的策略。职业发展计划包括肺癌的自然病史和临床方面的培训，以及开发和评估癌症患者-照顾者双方以技术为基础的干预措施的理论和研究方法。通过指导研究、课程作业、研讨会和定向学习经验的组合，申请者将发展必要的技能，以建立一个独立资助的研究计划，重点是改善患者和照顾者双方对癌症的身体和心理适应。