EHealth Mindful Movement and Breathing to Improve Gynecologic Cancer Surgery Outcomes

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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).