A Decision Aid for Cancer-Surviving Adolescents

描述（由申请人提供）：物质使用可能会改变癌症幸存青少年的健康状况，放大放疗和化疗的晚期效应，并导致肺，心血管和肝脏异常。青少年癌症幸存者挣扎着决定是像同龄人一样从事危险行为，还是听从健康专家的建议。2003年儿童肿瘤学小组迟发效应筛查指南提出了对危险行为咨询的需求。决策辅助工具帮助患者准备做出与其健康状况相关的决定。 本研究的目的是：1）测试假设，青少年癌症幸存者，谁收到决策援助，（认知行为技能计划），以提高决策技能（在风险行为及其与癌症治疗晚期效应的相互作用的背景下），将报告与常规护理组相比，干预后6个月和12个月的决策质量有所提高;和2）探索以下假设：与常规护理组相比，接受决策辅助的青少年癌症幸存者在干预后6个月和12个月将报告（a）保持或降低风险动机，和（B）保持或降低风险行为状态（吸烟、饮酒或非法药物使用）。这项前瞻性随机临床试验将在干预后6个月和12个月进行重复测量。三个儿科肿瘤诊所将参加。计算机辅助决策辅助将在12个月内提供7.5小时的联系。将招募240名14-19岁的青少年癌症幸存者。将使用两个亚组：那些在研究入组时报告参与至少一种风险行为的人和那些没有参与的人。青少年将通过临床时间表中的连续入组进行选择，并随机分配到每个亚组中的两组（常规或加强护理）中的一组。结果的措施是：决策，风险动机和风险行为的状态。在初次访视期间将给予决策辅助，然后在第2、4和6个月时将计算机的三个“电子助推器”邮寄回家。9个月时将使用电话保持联系。所有随访将通过电话进行监测。所有3个终点的所有测量都将在线完成，但认知量表除外，该量表仅在一个场合采用纸质形式。将在初始和12个月诊所访视的半结构化访谈期间收集数据。广义线性模型将用于数据分析。

DESCRIPTION (provided by applicant): Substance use may alter health status of cancer-surviving adolescents, amplifying late effects of radiation and chemotherapy, and resulting in pulmonary, cardiovascular, and liver abnormalities. Teen cancer survivors struggle with the decision whether to engage in risk behaviors like their peers or to follow the advice of their health professional. The 2003 Children's Oncology Group Late Effects Screening Guidelines addressed the need for risk behavior counseling. Decision aids help prepare patients to make decisions relevant to their health status. The aims of this study are to: 1) test the hypothesis that teen cancer survivors, who receive a decision aid (cognitive-behavioral skills program) to enhance decision-making skills (framed within the context of risk behaviors and their interaction with late effects of cancer treatment), will report increased quality decision making 6- and 12-months post-intervention compared with the usual care group; and 2) explore the hypothesis that teen cancer survivors, who receive the decision aid will report (a) maintained or lowered risk motivation, and (b) maintained or lowered risk behavior status (in smoking, alcohol consumption, or illicit drug use) 6- and 12-months post-intervention compared with the usual care group. This prospective, randomized clinical trial will use repeated measures at 6- and 12-months post-intervention. Three pediatric oncology clinics will participate. A computer-assisted decision aid will provide 7.5 hours contact over 12 months. 240 teen cancer survivors, ages 14-19, will be recruited. Two subgroups will be used: those who report engaging in at least one risk behavior at study entry and those who do not. Teens will be chosen by serial enrollment from the clinic schedule and randomly assigned to one of two groups (usual or enhanced care) within each subgroup. The outcome measures are: decision making, risk motivation, and risk behavior status. The decision aid will be administered during the initial visit, followed by three mailed home "e-boosters" for the computer at 2, 4, and 6 months. A telephone call will be used at 9 months to maintain contact. All follow-up will be monitored by telephone calls. All measures will be completed online at all 3 endpoints, except the cognitive scale, which will be paper format on one occasion only. Data will be collected during a semistructured interview for the initial and 12-month clinic visits. Generalized linear models will be used for data analyses.