Anxiety With Cancer in the Elderly (ACE): A Cognitive-Behavioral Interv

老年人癌症焦虑 (ACE)：认知行为干预

• 批准号: 9266720
• 负责人: Kelly McConnell
• 金额: $ 15.71万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9266720
• 关键词: Address; Adherence; Adult Children; Advance Care Planning; Advanced Malignant Neoplasm; Adverse effects; Age; Aging; Anxiety; Anxiety Disorders; Behavioral; Benchmarking; Cancer Center; Cancer Intervention; Cancer Patient; Caregivers; Caring; Clinical; Cognitive; Cognitive Therapy; Communication; Control Groups; Decision Making; Diagnostic; Distress; Dyspnea; Effectiveness; Elderly; Emotional; Enrollment; Environment; Fatigue; Feedback; Future; Geriatrics; Goals; Health Personnel; International; Internet; Intervention; Intervention Trial; K-Series Research Career Programs; Life; Malignant Neoplasms; Manuals; Medical Care Team; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentorship; Minority Groups; Modeling; Modification; Nausea; New York; Nurse Practitioners; Oncologist; Pain; Palliative Care; Participant; Pathological anxiety; Patients; Performance Status; Phase; Physical Performance; Polypharmacy; Population; Presbyterian Church; Provider; Psychiatric Diagnosis; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Personnel; Resources; Risk; Role; Sampling; Self Efficacy; Social Functioning; Social Workers; Spouses; Subgroup; Telephone; Terminal Disease; Time; Treatment Efficacy; Work; anxiety symptoms; anxiety treatment; base; cancer care; caregiver bereavement; caregiver interventions; caregiving; clinical care; clinically significant; cognitive function; coping; cost; cost effective; design; dosage; effective therapy; end of life; end of life care; experience; flexibility; improved; informal caregiver; medical schools; negative affect; novel; oncology; physical conditioning; post intervention; primary caregiver; psychologic; psychosocial; public health relevance; racial and ethnic; secondary outcome; social; therapy design; treatment adherence; treatment as usual; treatment response; young adult

DESCRIPTION (provided by applicant): This application proposes to develop and evaluate Anxiety with Cancer in the Elderly (ACE), a cognitive-behavioral therapy-based (CBT) intervention for anxiety designed to meet the unique needs of older adults (OAs; ≥65 years) with advanced cancer and their informal caregivers (spouse/partner, adult children). This study will develop ACE (Phase I); obtain feedback on ACE from cancer patients, their caregivers, and healthcare providers (Phase II); and examine the acceptability, feasibility, and efficacy of ACE (Phase III). Significance. Anxiety is prevalent in OA cancer patients and their informal caregivers and is associated with more severe physical side-effects, poor quality of life and treatment adherence, poor communication with the healthcare team, and a weaker patient-oncologist alliance. In addition, over half of advanced cancer patients who meet diagnostic criteria for a psychiatric disorder do not receive treatment. CBT is a well-validated treatment for anxiety. However, traditional CBT has not been tailored to meet the unique needs of OAs with advanced cancer and their caregivers. Specific Aims. This study will develop and evaluate the feasibility and acceptability of a CBT-based intervention for anxiety in OAs with advanced cancer and their informal caregivers. This study will also examine the impact of the intervention on anxiety, depression, quality of life, coping, and patient-oncologist communication and alliance. Long-Term Objectives. This study will support a more extensive examination of this intervention with larger more diverse samples, leading to a widely validated and disseminable intervention tailored to OAs with advanced cancer and their caregivers. Research Plan. For Phase I, ACE, a CBT intervention for OAs with advanced cancer will be developed. In Phase II, ten patients, age 65 years or older and their primary caregiver and ten healthcare providers with experience in geriatric care will be asked to review ACE and provide feedback. In Phase III, forty OA cancer patients with advanced cancer and clinically significant anxiety and their caregivers will be randomly assigned to ACE or usual care control condition. Patients will complete assessments at baseline, during the intervention, and post intervention. Environment. Participants will be recruited from the New York Presbyterian Cancer Center, one of the largest cancer care centers in NYC with ample patient availability. The PI will receive mentorship from internationally recognized clinical researchers and leaders in aging, psychooncology, and palliative care and will leverage the rich and diverse resources from the Weill Cornell Medical College (WCMC) Center for End-of- Life Research and the Division of Geriatrics and Palliative Care. Relevance to Aging. This study will provide a non-pharmacologic treatment that will reduce anxiety and improve quality of life in OAs with advanced cancer and their caregivers and will support future research on interventions for OAs of minority groups and with other life-limiting illnesses.

描述（由申请人提供）：本申请建议开发和评估老年人癌症焦虑症（ACE），这是一种基于认知行为疗法（CBT）的焦虑干预措施，旨在满足患有晚期癌症的老年人（OA；≥65岁）及其非正式照顾者（配偶/伴侣、成年子女）的独特需求。本研究将开发ACE（第一期）；从癌症患者、其护理人员和医疗保健提供者那里获取有关 ACE 的反馈（第二阶段）；并检查 ACE（III 期）的可接受性、可行性和有效性。意义。骨关节炎癌症患者及其非正式护理人员普遍存在焦虑情绪 并且与更严重的身体副作用、生活质量和治疗依从性差、与医疗团队沟通不畅以及患者与肿瘤科医生联盟较弱有关。此外，超过一半符合精神疾病诊断标准的晚期癌症患者没有接受治疗。 CBT 是一种经过充分验证的焦虑治疗方法。然而，传统的 CBT 并不能满足患有晚期癌症的 OA 及其护理人员的独特需求。具体目标。本研究将开发和评估基于 CBT 的干预措施的可行性和可接受性，以治疗患有晚期癌症的 OA 及其非正式护理人员的焦虑。这项研究还将探讨干预措施对焦虑、抑郁、生活质量、应对以及患者与肿瘤科医生沟通和联盟的影响。长期目标。这项研究将支持使用更大、更多样化的样本对这种干预措施进行更广泛的检查，从而针对患有晚期癌症的 OA 及其护理人员进行广泛验证和可传播的干预措施。研究计划。在第一阶段 ACE 中，将开发针对患有晚期癌症的 OA 的 CBT 干预措施。在第二阶段，将要求 10 名 65 岁或以上的患者及其主要护理人员和 10 名具有老年护理经验的医疗保健提供者审查 ACE 并提供反馈。在 III 期中，40 名患有晚期癌症和临床显着焦虑的 OA 癌症患者及其护理人员将被随机分配到 ACE 或常规护理对照条件组。患者将在基线、干预期间和干预后完成评估。环境。参与者将从纽约长老会癌症中心招募，该中心是纽约市最大的癌症护理中心之一，拥有充足的患者资源。 PI 将接受老龄化、心理肿瘤学和姑息治疗领域国际公认的临床研究人员和领导者的指导，并将利用威尔康奈尔医学院 (WCMC) 临终研究中心以及老年病学和姑息治疗部门丰富多样的资源。与老龄化的相关性。这项研究将提供一种非药物治疗，以减少患有晚期癌症的骨关节炎及其护理人员的焦虑并改善他们的生活质量，并将支持未来针对少数群体骨关节炎和其他限制生命疾病的干预措施的研究。