Using Technology to Deliver Evidence-Based Interventions for Pain to Patients with Sickle Cell Disease

项目摘要 该候选人研究计划的总体目标是改善行为和身体健康， 利用多媒体技术提供循证干预措施， 服务不足的人群。重点是镰状细胞病（SCD），一种不成比例地影响 那些非洲后裔。许多患有SCD的人患有日常慢性疼痛以及复发性急性疼痛。 需要医疗护理的疼痛发作。阿片类药物是SCD疼痛的主要治疗方法， 尽管其有效性有限且具有负面副作用。建议的K23试图解决以下需求： SCD中的替代非药物疼痛治疗。计算机认知行为治疗（cCBT） 并且可能是一种低成本、容易获得和可扩展的疼痛 SCD治疗候选人的K12项目测试了焦虑和抑郁的cCBT计划;初步 结果表明，患者喜欢使用该程序，但发现其大部分内容与他们的 生活为了解决这一限制，拟议的K23项目将调整现有的cCBT计划，以治疗疼痛 管理创建反思疼痛SCD，一个文化定制，手机提供的行为干预 专为帮助非裔美国患者自我管理慢性镰状细胞疼痛而设计。目标1：修改和 定制通用的cCBT疼痛计划，使用定性研究方法来了解需求和障碍 SCD患者的疼痛管理，以及使用 多媒体等这些数据将为开发ReThink Pain SCD的功能和内容提供信息。目标二： 进行试点务实的临床试验，以测试实施这一痛苦的可行性和可接受性 介入常规SCD护理。40例SCD患者将随机接受8次治疗， cCBT计划或智能手机上的8个在线教育模块。试验的主要结果包括 可行性（招募、保留、提供者和患者反馈）和可接受性（已完成的会议） 重新思考疼痛SCD计划。 为了实现本研究计划的目标并过渡到独立，候选人需要 进一步培训以用户为中心的设计，实施科学，设计和进行务实的临床 审判，团队管理和领导。该提案包括一个特殊的导师团队， 顾问。主要导师布鲁斯罗尔曼博士是行为健康中心的创始主任， 智能技术。合作导师罗伯特·诺尔博士是一位临床心理学家，在行为干预方面具有专长。 审判共同导师Laura De Castro博士是全国公认的镰状细胞病试验者和专家。这 培训和研究计划将成为未来多中心临床试验的基础，以测试ReThink的有效性 Pain SCD用于改善成人SCD患者的疼痛结局，将在R01赠款申请中提出 在K23奖结束之前。

PROJECT ABSTRACT The overarching goal of this candidate's program of research is to improve behavioral and physical health and reduce health disparities by using multimedia technology to deliver evidence-based interventions to underserved populations. The focus is sickle cell disease (SCD), a condition that disproportionately affects those of African descent. Many people living with SCD suffer from daily chronic pain as well as recurrent acute pain episodes that require medical attention. Opioid medication is the primary treatment for pain in SCD, despite its limited effectiveness and negative side-effects. The proposed K23 attempts to address the need for an alternative, non-pharmacological pain treatment in SCD. Computerized cognitive behavioral therapy (cCBT) has been found effective for reducing chronic pain and may be a low cost, easily accessible and scalable pain treatment in SCD. The candidate's K12 project tested a cCBT program for anxiety and depression; preliminary results suggest that patients liked using the program, but found that much of its content did not relate to their lives. To address this limitation, the proposed K23 project will adapt an existing cCBT program for pain management to create ReThink Pain SCD, a culturally-tailored, mobile-phone delivered behavioral intervention designed specifically to help African American patients self-manage chronic sickle cell pain. Aim 1: Modify and tailor the generic cCBT pain program, using qualitative research methods to understand the needs and barriers to pain management in patients with SCD, as well as the opportunities to engage this population using multimedia. These data will inform the development of the features and content of ReThink Pain SCD. Aim 2: Conduct a pilot pragmatic clinical trial to test the feasibility and acceptability of implementing this pain intervention into routine SCD care. Forty patients with SCD will be randomized to either receive 8 sessions of the cCBT program or 8 online education modules on a smartphone. Primary outcomes of the trial include feasibility (recruitment, retention, provider and patient feedback) and acceptability (sessions completed) of the ReThink Pain SCD program. In order to achieve the goals of this research plan and transition to independence, the candidate requires further training in user-centered design, implementation science, design and conduct of pragmatic clinical trials, and team management and leadership. This proposal includes an exceptional team of mentors and consultants. Primary mentor Dr. Bruce Rollman is founding Director of the Center for Behavioral Health and Smart Technology. Co-mentor Dr. Robert Noll is a clinical psychologist with expertise in behavioral intervention trials. Co-mentor Dr. Laura De Castro is a nationally recognized trialist and expert in sickle cell disease. This training and research plan will form the basis for a future multicenter clinical trial testing the efficacy of ReThink Pain SCD for improving pain outcomes among adults with SCD, to be proposed in an R01 grant application before the end of the K23 award.