Facilitating Advance Care Planning Discussions Between Patients with Advanced Cancer and Their Family Caregivers Using a Resilience-Building Intervention

使用增强复原力的干预措施促进晚期癌症患者及其家庭护理人员之间的预先护理计划讨论

• 批准号: 10661890
• 负责人: Li-Ting Huang Longcoy
• 金额: $ 11.48万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10661890
• 关键词: Address; Adolescent and young adult cancer patients; Advance Care Planning; Advance Directives; Advanced Malignant Neoplasm; Affect; Anxiety; Award; Awareness; Cancer Center; Caregivers; Caring; Clinical Trials; Communication; Coping Skills; Data; Decision Aid; Decision Making; Development; Distress; Emotional; Family Caregiver; Feeling; Foundations; Future; Goals; Health Professional; Healthcare; Hospice Care; Individual; Intervention; Knowledge; Malignant Neoplasms; Medical; Mental Depression; Modeling; Online Systems; Outcome; Palliative Care; Parents; Pathway interactions; Patients; Persons; Phase; Play; Positioning Attribute; Process; Psychology; Randomized, Controlled Trials; Reaction; Research; Research Design; Risk; Role; Secure; Symptoms; Testing; Training; Transact; Treatment Efficacy; Uncertainty; acceptability and feasibility; behavior change; comparative efficacy; coping; cost; design; digital; dissemination science; emotional distress; empowerment; end of life care; experience; health goals; implementation science; improved; insight; mortality; pilot test; primary outcome; promote resilience; protective effect; quality of death; randomized, clinical trials; resilience; satisfaction; secondary outcome; skill acquisition; skills; tenure track; theories; therapy development; treatment as usual; usability; web-based intervention

Project Summary This K99/R00 Pathway to Independence Award's overall goal is to develop and assess the feasibility and preliminary efficacy of a web-based resilience-building intervention to address patients with advanced cancer and their family caregivers’ appraisals of advance care planning (ACP) and individual and dyadic coping. ACP is a process to facilitate decision-making for future medical care. By supporting individuals in understanding and sharing their values and goals, ACP can help patients meet their goals for health care treatment, decrease the emotional burden of decision-making for family caregivers, and increase satisfaction with end-of-life care and quality of death. Avoidance of ACP can delay the introduction of palliative and hospice care and risk patients receiving costly and aggressive care that not only is goal- discordant but also increases family caregivers’ anxiety and depression. The rationale for a web-based resilience-building intervention is that patients and family caregivers can be empowered to accurately appraise and use appropriate coping strategies for ACP by increasing their resilience skills. Building resilience has shown promising results in reducing cancer distress in adolescents and young adults with cancer and their parents. The proposed study is guided by the Systemic Transactional Model and utilizes a dyadic intervention approach. The training goals of the proposed study are to (1) develop expertise in dyadic study design and intervention development for people with cancer and their caregivers; (2) gain specialized knowledge in digital positive psychology interventions; (3) gain skills in leading randomized controlled trials and dissemination and implementation science; and (4) secure a tenure-track position. The Specific Aims for the K99 phase are to (1) identify the ACP deliberation process among 20 dyads of patients with advanced cancer and family caregivers and (2) conduct usability testing among 9 dyads to refine the content and design of the web-based resilience-building intervention. The Specific Aims for the R00 phase are to (1) assess the feasibility and acceptability of the web-based resilience-building intervention among patients with advanced cancer and their family caregivers through a randomized clinical trial in a cancer center setting; (2) evaluate the preliminary efficacy of the intervention compared to usual care on changes in the completion of advance directives (primary outcome) and on patient and caregiver resilience, individual and dyadic coping, anxiety, and depression (secondary outcomes); and (3) explore the dyadic effects of resilience within patients with advanced cancer and their family caregivers on individual and dyadic coping, anxiety, and depression, using the Actor-Partner Interdependence Model. The expected outcomes are identification and development of the essential components of the web-based intervention (K99 phase) and data that provides a strong foundation for further development of the intervention for R01 applications and future research (R00 phase).

项目摘要 K99/R 00独立之路奖的总体目标是开发和评估可行性， 基于网络的依从性建设干预措施对晚期乳腺癌患者的初步疗效 癌症及其家庭照顾者对预先护理计划（ACP）的评价以及个人和二元 应对ACP是一个促进未来医疗决策的过程。通过支持个人 通过了解和分享他们的价值观和目标，ACP可以帮助患者实现健康目标 护理治疗，减少家庭照顾者决策的情感负担， 对临终关怀和死亡质量的满意度。避免使用机场核心计划， 姑息和临终关怀和风险患者接受昂贵的和积极的护理，不仅是目标， 不和谐，而且增加了家庭照顾者的焦虑和抑郁。基于网络的 建立依从性的干预措施是，患者和家庭护理人员可以被授权准确地 评估和使用适当的应对非加太国家的战略，提高他们的应变能力。建筑 恢复力在减少青少年和年轻人的癌症痛苦方面显示出有希望的结果， 癌症和父母本研究以系统性交易模型为指导， 一种二元干预方法。拟议研究的培训目标是：（1）培养以下方面的专门知识 针对癌症患者及其护理人员的二元研究设计和干预开发;（2）获得 数字积极心理学干预的专业知识;（3）获得领导随机 控制试验和传播与实施科学;（4）确保终身职位。 K99阶段的具体目标是：（1）在20个二元组中确定机场核心计划的审议过程， 晚期癌症患者和家庭照顾者，以及（2）在9对夫妇中进行可用性测试， 完善基于网络的自律建设干预措施的内容和设计。具体目标 R 00阶段的主要任务是：（1）评估基于Web的协同性建设的可行性和可接受性 晚期癌症患者及其家庭照顾者的干预， 在癌症中心进行的临床试验;（2）评估干预措施的初步疗效， 在完成预先指示（主要结局）和患者方面的变化， 照顾者的弹性，个人和二元应对，焦虑和抑郁（次要结果）; (3)探讨晚期癌症患者及其家庭中复原力的二元效应 照顾者对个人和二元应对，焦虑和抑郁，使用演员合作伙伴 相互依赖模型。预期成果是确定和发展基本的 基于网络的干预（K99阶段）的组成部分和数据，为 进一步制定R 01应用和未来研究的干预措施（R 00阶段）。