Recovery Support for Bladder CA Patients and Caregivers: A Multimodal Approach

膀胱 CA 患者和护理人员的康复支持：多模式方法

• 批准号: 10672260
• 负责人: Michael A Diefenbach
• 金额: $ 49.72万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10672260
• 关键词: Address; Aftercare; Age; Area; Attention; Bladder; Body Image; Cancer Intervention; Cancer Patient; Caregivers; Caring; Categories; Climacteric; Clinical; Combined Modality Therapy; Complex; Cost Analysis; Data; Data Analyses; Development; Diagnosis; Disease; Distress; Education; Emergency Care; Emergency department visit; Evaluation; Excision; Face; Feeling; Female; Fright; Future; Gender; Goals; Health Professional; Health Promotion; Home visitation; Hospitals; Ileal conduit procedure; Infection; Information Resources; Instruction; Intervention; Knowledge; Learning; Literature; Maintenance; Malignant neoplasm of urinary bladder; Mediating; Mediator; Medical; Modeling; Online Systems; Operative Surgical Procedures; Participant; Patient Care; Patients; Persons; Phase; Physicians; Pilot Projects; Preparation; Prostate; Publishing; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Recovery Support; Recurrence; Regimen; Research; Research Methodology; Sampling; Savings; Self Care; Self Efficacy; Spouses; Stomas; System; Technology; Testing; Time; Treatment Efficacy; Visit; Visiting Nurse; Work; caregiving; clinical application; clinical care; comparison group; coping; cost; cost effective; experience; group intervention; health training; human old age (65+); implementation cost; improved; innovation; intervention cost; intervention effect; lymph nodes; multimodality; muscle invasive bladder cancer; novel; primary outcome; programs; psychologic; psychosocial; readmission rates; secondary outcome; skills; social; standard of care; survivorship; therapy design; usability; web-based intervention

ABSTRACT Treatment for muscle invasive bladder cancer (MIBC) involves the removal of the bladder and construction of a new voiding system and is physically and psychologically profoundly challenging for patients and caregivers. Based on our published literature and extensive pilot data, patients and caregivers have extensive unmet informational, social, psychological, instrumental, and medical needs from the time of diagnosis, through treatment and recovery which are not adequately addressed by health care professionals. We propose to address these unmet needs through the refinement and evaluation of a comprehensive, 2-part (in-person and web-based) intervention, geared towards the patient and caregiver. Specifically, during Aim 1, the formative phase, we propose to further refine our newly developed intervention components with the help of an established patient/caregiver advisory board. The intervention, Recovery Support for Bladder Cancer (RSBC), consists of a pre-treatment, in-person preparatory instructional session with a trained health care professional (Module 1) to equip patients and caregivers with the skills to adjust to the upcoming treatment and recovery period. This is followed by a post-treatment, interactive web-based program (Module 2) to provide further support for both patients and caregivers to enhance quality of life (QOL) and reduce infections and nurse/ER visits. The RSBC intervention will be evaluated in a 12-month randomized controlled trial (Aim 2) among patients and caregiver dyads (N=330 initial; 230 final sample) against a time and attention comparison condition that incorporates standard of care discharge instructions and modules focusing on wellness. Primary outcomes for both patients and caregivers will be improved QOL, which is hypothesized to be significantly higher among participants randomized into RSBC. Secondary outcomes will be fewer infections and nurse- ER visits for patients randomized into RSBC. Aim 3 proposes moderator (i.e., age, gender, surgical diversion type) and mediator (i.e., patient activation, distress) analyses of intervention efficacy. We hypothesize that RSBC will be significantly more successful among (a) older, (b) female participants, and (c) patients with a conduit diversion type. Elevated levels of patient activation (i.e., higher self-care knowledge, self-efficacy, lower distress) will mediate the intervention effects. Exploratory Aim 4 will examine the costs and potential savings associated with developing and implementing the RSBC intervention. We hypothesize that initial development and implementation costs of RSBC will be offset by reduced nurse/ER visits. The scientific premise is strong and supported by an established theoretical framework, extensive pilot data and a rigorous application of clinical research methods. The proposed study is highly innovative, as it comprehensively addresses unmet needs of both patients and caregivers from pre- and (immediate) post-treatment to recovery. This is achieved through an innovative combination of in-person preparation and skill-building and web-based technology. If successful, RSBC has the potential to significantly change clinical care for patients and caregivers with MIBC.

摘要

项目成果

Management of Distress in Patients with Cancer-Are We Doing the Right Thing?

• DOI: 10.1093/abm/kaaa091
• 发表时间: 2020-12-01
• 期刊: Annals of behavioral medicine : a publication of the Society of Behavioral Medicine
• 作者: Dekker J;Graves KD;Badger TA;Diefenbach MA
• 通讯作者: Diefenbach MA

Patterns of alcohol use among early head and neck cancer survivors: A cross-sectional survey study using the alcohol use disorders identification test (AUDIT).

• DOI: 10.1016/j.oraloncology.2021.105328
• 发表时间: 2021-08
• 期刊: ORAL ONCOLOGY
• 影响因子: 4.8
• 作者: Teckie, Sewit;Wotman, Michael;Marziliano, Allison;Orner, David;Yi, Jungen;Mulvany, Colm;Ghaly, Maged;Parashar, Bhupesh;Diefenbach, Michael A.
• 通讯作者: Diefenbach, Michael A.