Pathway to Equity: Feasibility and Proof of Concept of Meaning-Centered Psychotherapy for Chinese Patients with Advanced Cancer

项目摘要 亚洲人是美国增长最快的种族/族裔群体，也是唯一一个癌症，而不是 心脏病是导致死亡的主要原因。最大的亚洲亚群是中国血统，其中许多人 外国出生者（76%）和英语水平有限（LEP）者（48%）。外国出生的中国人更有可能是 被诊断为癌症晚期的人比在美国出生的中国人多。许多晚期癌症患者 精神和情感上的痛苦，临终的绝望和绝望，使他们的疾病复杂化 管理以意义为中心的心理治疗（MCP）是一种手动干预， 成功提升晚期癌症病人的意义感，以改善他们的精神健康， 生活质量然而，MCP的疗效在一项随机对照试验中进行了测试， 主要是白色（76%）的样本，并没有检查干预对亚洲人作为一个群体的影响。 研究表明，为特定文化群体量身定制的文化适应性治疗方法是传统治疗方法的四倍。 比提供给来自各种文化背景的参与者的干预措施更有效， 用LEP参与者的母语进行的干预是用英语进行的干预的两倍。 这对中国癌症患者尤其重要，因为中国癌症患者具有独特的社会文化风险因素。 未经治疗的痛苦，需要治疗适应，包括对癌症的自我耻辱和相关的耻辱 寻求心理健康服务对于中国患者，除了潜在的身体问题外， 所有癌症患者可能面临的移动和交通问题，远程医疗提供的心理健康 干预-减少公共责任-可能具有很大的效用。因此，迫切需要发展 为中国晚期癌症患者提供文化定制的远程心理社会干预。 为了解决这一差距，在我们的初步工作中，我们进行了形成性研究，以评估心理社会和 以意义为中心的中国晚期癌症患者的需求。这项工作导致了最初的 为中国晚期癌症患者（MCP-Ch）制定6节MCP干预手册， 简体中文和生成的领域进行补充查询，即需要审查和完善 治疗内容与心理健康专家的输入，并确定可能影响 在未来的试验中实施远程保健提供的MCP-Ch。在这项研究中，我们将（1）改进MCP-Ch 提高文化和语言的可接受性和可理解性，并评估可能 影响MCP-Ch的实施，基于15名心理健康提供者的利益相关者反馈， 中国癌症患者。然后我们将（2）确定可行性和初步的事前事后效果 27例中国普通话III/IV期实体瘤患者的远程医疗MCP-Ch 任何类型的癌症（n=20例完成者，具有预期损耗）。这项研究的结果将填补一个关键的空白， 目前对这个庞大的、不断增长的、服务不足的群体的心理社会护理。

PROJECT ABSTRACT Asians are the fastest growing racial/ethnic group in the United States and the only group for which cancer, not heart disease, is the leading cause of death. The largest Asian subgroup is of Chinese origin, many of whom are foreign-born (76%) and limited English proficient (LEP) (48%). Foreign-born Chinese are more likely to be diagnosed with cancer at an advanced stage than U.S. born Chinese. Many advanced cancer patients suffer from spiritual and emotional distress, end-of-life despair, and hopelessness, complicating their illness management. Meaning-Centered Psychotherapy (MCP) is a manualized intervention with demonstrated success in enhancing advanced cancer patients’ sense of meaning to improve their spiritual well-being and quality of life. However, MCP’s efficacy was tested in a randomized controlled trial with an English speaking, predominantly White (76%) sample, and did not examine the impact of the intervention on Asians as a group. Studies have shown culturally adapted treatments tailored for a specific cultural group are four times more effective than interventions provided to participants from a variety of cultural backgrounds, and those conducted in LEP participants’ native language are twice as effective as interventions conducted in English. This may be especially important for Chinese cancer patients because of unique sociocultural risk factors for untreated distress that require treatment adaptation, including self-stigma about cancer and stigma associated with seeking mental health services. For Chinese patients with stigma concerns in addition to potential physical mobility and transportation issues that all cancer patients may face, telehealth-delivered mental health interventions—which reduce public visibility—may be of great utility. There is thus a critical need to develop culturally tailored, remotely accessible psychosocial interventions for Chinese patients with advanced cancer. To address this gap, in our preliminary work, we conducted formative research to assess the psychosocial and meaning-centered needs of Chinese patients with advanced cancer. This work resulted in the initial development of a 6-session MCP intervention manual for Chinese patients with advanced cancer (MCP-Ch) in Simplified Chinese and generated areas for additional inquiry, namely, the need to review and refine therapeutic content with input from mental health experts and to identify contextual factors that may affect implementation of telehealth-delivered MCP-Ch in future trials. In this study, we will (1) refine MCP-Ch materials to enhance cultural and linguistic acceptability and comprehensibility and assess factors that may affect MCP-Ch’s implementation, based on stakeholder feedback from 15 mental health providers who work with Chinese cancer patients. We will then (2) determine the feasibility and preliminary pre-post effectiveness of telehealth-delivered MCP-Ch among 27 Mandarin-speaking Chinese patients with Stage III/IV solid tumor cancers of any type (n=20 completers with expected attrition). Results from this study will fill a critical gap in current psychosocial care for this large, growing, and underserved group.