eHealth Supported Mindfulness-based Music Therapy Intervention (eMBMT) in Hemopoietic Stem Cell Transplant Patients

异基因造血干细胞移植(allo-sct)是一种治疗多种疾病的潜在方法。 恶性血液病。由于强化调理方案(如放射治疗、化疗)和 移植后并发症，异基因干细胞移植与多种生理和心理副作用有关 包括症状负担(如疲劳、疼痛)、心理社会功能差和情绪困扰 (例如，焦虑、抑郁)，损害与健康相关的生活质量(HRQOL)，并发生在 遵循严格的自我管理方案，以预防与治疗有关的并发症。小说， 综合性、参与性、低需求和可扩展的计划，以减轻症状负担并改善与健康相关的问题 在allo-SCT中需要生活质量(HRQOL)和健康结果，然而有限的工作解决了 开发和实施音乐疗法--一种有益于健康的治疗方法 癌症幸存者的结局。基于正念的音乐疗法(MBMT)融合了 正念和定制的音乐干预组件(例如，歌曲创作、乐器演奏)由 训练有素的音乐治疗师。我们的跨学科团队已经证明：(A)MBMT可以减少负面情绪、疲劳、 乳腺癌幸存者的焦虑和焦虑，(B)压力管理和正念改善生理 不同癌症存活人群的调整(例如，减少炎症)和HRQOL，以及(C) 电子健康平台可以促进有效地向癌症患者和幸存者提供心理社会干预。 然而，在制定和评估设计良好、可行、可接受、 而可重复的电子健康促进的MBMT(EMBMT)干预措施用于改善患者预后是有限的。 此外，具体的音乐治疗成分如何影响心理社会(例如，焦虑、抑郁)和 生理机制(如炎症、免疫活性)还不是很清楚。使用我们的 在混合方法、eHealth、allo-SCT和MBMT方面的专业知识，我们解决了这些差距，并建议 建立一种新型eHealth促进eMBMT减轻症状的可接受性、可行性和预期效果 负担和改善HRQOL(主要结果)，改善心理社会和生理适应 (例如，癌症痛苦、炎症减轻、T细胞恢复/免疫重建)(eMBMT机制)， 以及改善接受allo-SCT的患者的疾病活动性(例如，GVHD)(次要结果)。在 R61阶段，我们实施混合方法(例如，焦点小组、小型RCT)设计，以最终确定eMBMT和 正念冥想(EMM)控制条件，确立可行性，开始确定音乐疗法 对我们的研究结果/机制产生积极影响的组件。在我们的R33阶段，我们进行了更大规模的 根据R61调查结果进行的试点随机对照试验，以确定eMBMT音乐治疗组件对 HRQOL、症状负担、心理社会和生理适应。研究结果将指导大规模随机对照试验 有长期的随访和额外的临床结果。

Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a potentially curative procedure for many hematologic malignancies. Due to the intensive conditioning regimen (e.g., radiotherapy, chemotherapy) and post-transplant complications, allo-SCT is associated with multiple physical and psychological side effects including symptom burden (e.g., fatigue, pain), and poor psychosocial function and emotional distress (e.g., anxiety, depression) that impair health-related quality of life (HRQoL), and occur within the context of following a strict self-management protocol to prevent treatment-related complications. Novel, integrative, engaging, low-demand and scalable programs to reduce symptom burden and improve health related quality of life (HRQoL) and health outcomes in allo-SCT are needed, yet limited work has addressed the development and implementation music therapy—a therapeutic approach that can favorably impact health outcomes in cancer survivors. Mindfulness-based music therapy (MBMT) blends core elements of mindfulness and tailored music intervention components (e.g., songwriting, instrument playing) delivered by a trained music therapist. Our transdisciplinary team has shown that (a) MBMT reduces negative mood, fatigue, and anxiety in breast cancer survivors, (b) stress management and mindfulness improve physiological adjustment (e.g., reduced inflammation) and HRQoL in various cancer survivorship populations, and (c) that eHealth platforms can facilitate effective delivery of psychosocial interventions in cancer patients and survivors. However, studies implementing the first step in developing and evaluating well-designed, feasible, acceptable, and reproducible eHealth facilitated MBMT (eMBMT) interventions to improve patient outcomes are limited. Further, how specific music therapy components impact psychosocial (e.g., anxiety, depression) and physiological (e.g., inflammation, immunocompetence) mechanisms is not well understood. Using our expertise in mix-methods approaches, eHealth, allo-SCT, and MBMT, we address these gaps and propose to establish acceptability, feasibility and intended effects of a novel eHealth facilitated eMBMT in reducing symptom burden and improving HRQoL (Primary Outcomes), improving psychosocial and physiological adaptation and (e.g., cancer distress, reduced inflammation, T-cell recovery/immune reconstitution) (eMBMT Mechanisms), and ameliorating disease activity (e.g., GVHD) (Secondary Outcomes) in patients undergoing allo-SCT. In the R61 Phase we implement a mixed-methods (e.g., focus groups, small RCT) design to finalize eMBMT and a mindfulness meditation (eMM) control condition, establish feasibility and begin to identify music therapy components that favorably impact our study outcomes/mechanisms. In our R33 Phase we conduct a larger scale pilot RCT informed by the R61 findings to establish intended effects of eMBMT music therapy components on HRQOL, symptom burden and psychosocial and physiologic adaptation. Findings will guide a large-scale RCT with long-term follow-up and additional clinical outcomes.