EHealth Mindful Movement and Breathing to Improve Gynecologic Cancer Surgery Outcomes

项目总结 改善急性围手术期疼痛和并存症状(即睡眠障碍、 因疑似妇科恶性肿瘤而接受手术的女性可能 主动接触高危人群，减轻慢性疼痛的总体负担。事实上，患者是 女性、做过手术和被诊断为癌症是最容易患上慢性病的亚群。 疼痛。心理-身体干预通常是寻求非药物方法治疗疼痛和其他 症状管理，特别是癌症患者的症状管理。瑜伽是一种多模式的身心干预，可能 通过心理和生理机制以最佳方式解决疼痛和共病症状 受止痛药的影响。与其他非药物干预相比，瑜伽具有潜在的优势 因为它的多个组成部分也支持通常的护理目标，即鼓励流动性和深度 呼吸，从而可能改善其他手术并发症(如肠梗阻、深静脉血栓形成)。这个 建议的正念运动和呼吸(MMB)简短的瑜伽干预是创新的，因为它适应了关键 从长期干预到短期干预的要素，可以在急性期间实施 围手术期的时间表。拟议的研究将适应已经开发的面对面MMB干预 和面对面注意力控制(AC)到电子健康格式(AIM I)。AIM II将实地测试实施战略 对于由此产生的eMMB，AIM III将确定eMMB和AC的可行性和可接受性，以减少 一项在接受治疗的女性中进行的探索性随机临床试验 疑似妇科恶性肿瘤的外科手术。发展和评估交流小组在一个 电子健康干预将有助于拟议研究的下一阶段，并可能适用于 对更广泛的身心干预的研究。在进行这项可行性研究后，我们会进行全面的- 对优化的eMMB在减少疼痛、睡眠障碍和 妇科癌症手术后的心理困扰。干预的简洁性和可及性，以及 瑜伽的日益普及，使eMMB成为未来传播的有力候选者。如果我们 证明eMMB在改善接受手术的妇女的手术结果方面的有效性 怀疑为妇科恶性肿瘤，结果可能适用于其他围手术期患者，并具有 对减少受慢性疼痛影响的日益增长的人口具有重要的公共卫生影响。建议数 研究涉及国家补充和综合健康中心概述的优先事项(即， 研究一种心身结合的症状管理方法)。

PROJECT SUMMARY Improved management of acute perioperative pain and co-morbid symptoms (i.e., sleep disturbances, psychological distress) among women undergoing surgery for suspected gynecologic malignancies may proactively reach an at-risk population and reduce the overall burden of chronic pain. In fact, patients who are women, have surgery, and are diagnosed with cancer are among the subgroups most vulnerable to chronic pain. Mind-body interventions are commonly sought after nonpharmacological approaches for pain and other symptom management, particularly in cancer patients. Yoga is a multimodal mind-body intervention that may optimally address pain and co-morbid symptoms through psychological and physiological mechanisms not affected by pain medication. Yoga has a potential advantage over other nonpharmacological interventions because of its multiple components that also support the usual care goals of encouraging mobility and deep breathing and thus may improve additional surgical complications (e.g., ileus, deep venous thrombosis). The proposed Mindful Movement and Breathing (MMB) brief yoga intervention is innovative because it adapts key elements of a longer intervention to a short-term format that can be implemented during the acute perioperative timeframe. The proposed research will adapt the already developed in-person MMB intervention and in-person attention control (AC) to an eHealth format (Aim I). Aim II will field test implementation strategies for the resulting eMMB, and Aim III will determine feasibility and acceptability of the eMMB and AC to reduce pain and other surgical outcomes through an exploratory randomized clinical trial among women undergoing surgery for suspected gynecologic malignancies. Developing and assessing the feasibility of an AC group in an eHealth intervention will be instrumental for the next stages of the proposed research and may be applicable to the study of mind-body interventions more broadly. Following this feasibility study, we will conduct a fully- powered investigation of the efficacy of the optimized eMMB for reducing pain, sleep disturbance, and psychological distress after gynecologic cancer surgery. The brevity and accessibility of the intervention, and the increasing popularity of yoga, make the eMMB a strong candidate for future dissemination. If we demonstrate efficacy of the eMMB for improving surgical outcomes of women who undergo surgery for a suspected gynecologic malignancy, results may be generalizable to other perioperative patients and have important public health implications for reducing the growing population affected by chronic pain. The proposed research addresses priorities outlined by the National Center for Complementary and Integrative Health (i.e., investigates a mind-body approach for symptom management).