Using Real Time Mobile Health Approaches to Understand and Promote Oral Chemotherapy Adherence in Adolescents and Young Adults with Leukemia

使用实时移动健康方法来了解和促进患有白血病的青少年和年轻人的口服化疗依从性

• 批准号: 10688202
• 负责人: Alexandra Psihogios
• 金额: $ 12.89万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10688202
• 关键词: 6-Mercaptopurine; Acute Lymphocytic Leukemia; Address; Adherence; Adolescent and Young Adult; Adolescent and young adult cancer patients; Affect; Age; Behavior Therapy; Cancer Control; Cancer Patient; Caregivers; Chronic; Clinical; Clinical Trials; Conduct Clinical Trials; Cross-Sectional Studies; Data; Data Collection; Development; Development Plans; Disease; Dissemination and Implementation; Ecological momentary assessment; Environment; Family; Fatigue; Feedback; Focus Groups; Goals; Health; Health behavior; Home; Individual; Intervention; Intervention Trial; Knowledge; Life; Maintenance; Malignant Childhood Neoplasm; Malignant Neoplasms; Medical; Mentorship; Methodology; Methods; Monitor; Moods; Motivation; Oral; Outcome; Patient Recruitments; Patients; Pharmaceutical Preparations; Phase; Population; Preparation; Process; Protocols documentation; Publishing; Randomized; Relapse; Research; Research Personnel; Research Priority; Risk; Role; Sampling; Science; Scientist; Self Management; Specific qualifier value; Survival Rate; Targeted Research; Techniques; Testing; Time; Training; Treatment outcome; Work; acceptability and feasibility; adaptive intervention; adherence rate; age group; behavior change; cancer health disparity; cancer therapy; career; career development; chemotherapy; cohort; contextual factors; design; effective intervention; forgetting; handheld mobile device; health assessment; improved; individual variation; leukemia; longitudinal design; mHealth; mHealth methodology; modifiable behavior; multidisciplinary; negative mood; novel; personalized intervention; physical symptom; pilot test; randomized trial; relapse prevention; research and development; skill acquisition; skills; statistics; success; technological innovation; theories; therapy adherence; therapy development; treatment adherence

PROJECT SUMMARY/ABSTRACT Stagnant survival and relapse rates for adolescents and young adults (AYA) with cancer are partially attributed to a modifiable health behavior—suboptimal cancer treatment adherence. Yet, effective interventions are lacking. Aligned with priorities of the NCI and other federal agencies, the long-term objective of this K08 application is to help resolve disparities in cancer treatment outcomes in AYA by targeting nonadherence to life-saving cancer treatments. The goal of this proposal is to employ novel real time mobile health methodologies to examine and intervene on the time-varying, contextual factors that influence AYA adherence to an oral chemotherapy called 6-mercaptopurine, which must be taken daily in the maintenance phase to prevent relapse. In Aim 1, the PI and her mentorship team will determine the temporal associations between time-varying contextual factors (such as fatigue, motivation) and daily 6-mercaptopurine adherence. This Aim will utilize a 6-month intensive longitudinal design that employs bursts of mobile-based ecological momentary assessment with AYA patients and their caregivers (n=30 pairs). In Aim 2, the investigative team will begin to develop a just-in-time adaptive mobile intervention, designed to promote 6-mercaptopurine adherence in this population, by developing contextually-tailored mobile messages and decision rules about the conditions under which to deliver the messages. Just-in-time mobile interventions are well-suited to address limitations of previous interventions by providing personalized adherence support, at the right time, only when it is needed. The creation of messages and decision rules will follow a rigorous mobile health development approach by iteratively incorporating self-management theory, empirical evidence, expert input, and stakeholder feedback. Focus groups with 15 AYA from Aim 1 will be conducted to user-test and refine the messages. In Aim 3, the just-in-time adaptive mobile intervention called AYA ADAPTS (Adherence Assessments and Personalized Timely Support) will be pilot tested in a micro-randomized trial with 30 newly recruited patients. AYA ADAPTS will integrate the tailored mobile messages and decision rules developed and refined in Aim 2. The research team will determine the feasibility and acceptability of this intervention in preparation for the PI's larger-scale optimization trial (R01 proposal). This proposal has methodological, theoretical, clinical, and technological innovations. The research and career development plan, supported by a multi-disciplinary team of experts in a rich academic environment, will support the PI's transition to an independent clinician-scientist who possesses the skills and expertise to use cutting-edge mobile health methods to design the most potent adherence- promotion interventions for pediatric cancer patients. This K08 will provide opportunities to acquire skills and knowledge in: (1) ecological momentary assessment and multi-level statistics, (2) behavior change intervention development applied to mobile health, and (3) the conduct of clinical trials and intervention dissemination and implementation.

项目摘要/摘要 青少年和年轻人（AYA）癌症患者的生存率和复发率停滞不前， 到一个可改变的健康行为-次优的癌症治疗依从性。然而，有效的干预措施 缺乏与NCI和其他联邦机构的优先事项保持一致，K 08的长期目标 应用程序是通过针对不依从性， 挽救生命的癌症治疗该提案的目标是采用新颖的真实的时间移动的健康 检查和干预影响AYA依从性的时变背景因素的方法 口服化疗称为6-巯基嘌呤，必须采取每天在维持阶段， 防止复发。在目标1中，PI和她的指导团队将确定 随时间变化的背景因素（如疲劳、动机）和每日6-巯基嘌呤依从性。这一目标 将采用为期6个月的密集纵向设计，采用基于移动的生态瞬间爆发 AYA患者及其护理人员的评估（n=30对）。在目标2中，调查小组将开始 开发一种及时的适应性移动的干预，旨在促进6-巯基嘌呤的坚持， 人口，通过开发上下文定制的移动的消息和决策规则的条件下 用来传递信息即时移动的干预非常适合解决 通过提供个性化的依从性支持，在正确的时间，只有当它是必要的。 消息和决策规则的创建将遵循严格的移动的健康发展方法， 迭代地整合自我管理理论、经验证据、专家意见和利益相关者反馈。 由目标1的15名AYA组成的焦点小组将进行用户测试和改进信息。在目标3中， 即时自适应移动的干预称为AYA ADAPTS（依从性评估和个性化 及时支持）将在一项有30名新招募患者的微型随机试验中进行初步测试。AYA适应 将整合目标2中开发和完善的定制移动的消息和决策规则。研究 团队将确定这种干预的可行性和可接受性，为PI的更大规模研究做准备 优化试验（R 01提案）。该建议具有方法论，理论，临床和技术 创新。研究和职业发展计划，由一个多学科的专家小组在一个 丰富的学术环境，将支持PI过渡到一个独立的临床科学家谁拥有 使用尖端的移动的健康方法来设计最有效的依从性的技能和专业知识- 对儿童癌症患者的宣传干预。K 08将提供获得技能的机会， 了解：（1）生态瞬时评估和多层次统计，（2）行为改变干预 发展适用于移动的保健，和（3）进行临床试验和干预传播， 实施.

项目成果

Daily text message assessments of 6-mercaptopurine adherence and its proximal contexts in adolescents and young adults with leukemia: A pilot study.

• DOI: 10.1002/pbc.28767
• 发表时间: 2021-02
• 期刊: PEDIATRIC BLOOD & CANCER
• 影响因子: 3.2
• 作者: Psihogios, Alexandra M.;Li, Yimei;Ahmed, Annisa;Huang, Jing;Kersun, Leslie S.;Schwartz, Lisa A.;Barakat, Lamia P.
• 通讯作者: Barakat, Lamia P.

Pediatric Psychosocial Standards of Care in action: Research that bridges the gap from need to implementation.

• DOI: 10.1002/pon.5505
• 发表时间: 2020-12
• 期刊: Psycho-oncology
• 影响因子: 3.6
• 作者: Wiener L;Canter K;Long K;Psihogios AM;Thompson AL
• 通讯作者: Thompson AL