The Promoting Resilience in Stress Management (PRISM) Intervention: a multi-site randomized controlled trial for Adolescents and Young Adults receiving Hematopoietic Cell Transplantation

项目摘要 青少年恶性血液病的造血细胞移植治疗体会 和年轻人(AYA)尤其困难，因为与年龄相关的身份发展挑战， 人际关系和职业可能会增加癌症的负担。与其他年龄段相比，AYA 较差的心理社会结果，包括更多的焦虑和抑郁，以及较差的口头依从性 免疫抑制药物可能导致Ayas的疾病相关发病率和/或 癌症复发。改善这些体验的一个潜在障碍可能是AYA几乎没有机会 开发应对逆境所需的个人资源。我们之前已经开发了“推广” 压力管理中的弹性“(PRISM)对患有严重疾病的AYA进行干预。这是一个简明扼要的手册 干预在4个30-60分钟的一对一会议中进行，随后是父母/护理者/配偶/ 其他重要的包容性会议。它的目标是压力管理和正念、目标设定、 积极的重组和意义的创造。AYA中2期随机对照试验的结果 与新诊断的癌症有关的研究表明，棱镜与心理痛苦的减少和 提高与健康相关的生活质量。这项研究将建立在我们先前经验的基础上，并填补了关键知识 在接受HCT的AYA中，关于PRISM的影响存在差距。因此，我们将进行多点随机 在N=70名AYA(n=35名PRISM和n=35名普通护理人员；年龄12-24岁)中进行对照试验，并进行初步试验 患者报告的焦虑和抑郁症状的结果。我们假设，那些收到 棱镜将报告更少的混合情感症状，表现出更好的依从性，并表现出改善 生物医学结果，而他们的父母报告生活质量和心理痛苦的改善。本研究 提供了一个机会来扩大关于方法严谨和证据的知识体系- 以心理社会干预为基础的恶性血液病患者的护理标准 有可能减轻这些脆弱人群中的癌症负担。 在这份拟议的多样性补充材料中，我将有助于评估PRISM在减少肺炎症状方面的有效性 通过协助与招募有关的程序，在HCT后的头6个月内出现焦虑和抑郁， 数据收集，并进行分析。

PROJECT ABSTRACT The experience of hematopoietic cell transplantation (HCT) for hematologic malignancy among Adolescents and Young Adults (AYAs) is particularly difficult because age-related developmental challenges of identity, relationships, and vocation may add to the burden of cancer. Compared to other age-groups, AYAs have poorer psychosocial outcomes including increased anxiety and depression and poorer adherence to oral immunosuppressive medications potentially predisposing AYAS to disease-related morbidity and and/or cancer-relapse. A potential barrier to improving these experiences may be that AYAs have few opportunities to develop the personal resources needed to handle adversity. We have previously developed the “Promoting Resilience in Stress Management” (PRISM) intervention for AYAs with serious illness. This manualized, brief intervention is delivered in 4, 30-60-minute, one-on-one sessions, followed by a Parent/ Caregiver/ Spouse/ significant other inclusive meeting. It targets skills in stress-management and mindfulness, goal-setting, positive reframing, and meaning-making. Findings from a phase 2 randomized controlled trial among AYAs with newly diagnosed cancer demonstrate that PRISM is associated with decreased psychological distress and increased health-related quality of life. This study will build on our prior experience and fill a critical knowledge gap regarding PRISM’s impact among AYAs receiving HCT. Thus, we will conduct a multi-site randomized controlled trial among N=70 AYAs (n=35 PRISM and n=35 usual care; ages 12-24 years), with the primary trial outcome of patient-reported symptoms of anxiety and depression. We hypothesize that AYAs who receive PRISM will report fewer mixed affective symptoms, demonstrate better adherence, and show improved biomedical outcomes, while their parents report improved quality of life and psychological distress. This study offers an opportunity to expand the body of knowledge regarding methodologically rigorous and evidence- based psychosocial interventions and standards of care for AYAs with hematologic malignancies and has the potential to reduce the burden of cancer in these vulnerable populations. In this proposed diversity supplement, I will contribute to evaluating PRISM’s efficacy in reducing symptoms of anxiety and depression over the first 6-months post-HCT by assisting with procedure related to recruitment, data collection, and analysis.