Recovering Together after Cardiac Arrest: A dyadic mind-body intervention for emotional distress in cardiac arrest survivors and their informal caregivers

项目总结 在这份K23提案中，我详细介绍了一项为期5年的培训计划，该计划将开启我作为一名独立调查员的职业生涯，专注于为心脏骤停(CA)幸存者及其家人开发和实施心身干预。背景：经历CA的经历是持续的创伤，导致幸存者(高达61%)及其非正式照顾者(高达40%)的情绪困扰。与其他已建立生存计划的危重人群不同，CA幸存者-照顾者二人组(对)资源不足，没有准备好管理生存，这加剧了情绪痛苦。CA术后未经治疗的情绪困扰成为慢性疾病，并破坏临床和生活质量结果。在CA术后早期通过传授身心技能和提供资源来解决情绪困扰，可能会预防慢性情绪困扰，提高生活质量。具体目标：我计划为神经恢复良好的CA幸存者和他们的非正式照顾者(“心脏骤停后一起恢复；RT-CA)”开发、改进和测试对CA幸存者和他们的非正式照顾者进行心身双向干预的可行性和可接受性。我的目标有三个：1)通过循证框架(二元相互依赖、反应转移框架、家庭力量脆弱性模型、作为过程的复原力)和循证技能(来自认知行为疗法、辩证行为疗法、接受和承诺疗法以及基于正念的压力缓解)、来自CA幸存者-照顾者二元组(N=~12个二元)的访谈以及焦点小组和与CA医疗利益相关者(N=16-24个利益相关者)的访谈来发展RT-CA；2)通过开放式试点(N=5个二元)结合退出访谈(以获得反馈)和预评估(用于初步可行性和可接受性)来改进RT-CA；3)通过RT-CA的先导性随机临床试验(RCT)测试RT-CA的可行性和可接受性(N=42个DADS)，并与最低限度增强的普通对照进行比较。培训：我的研究目标得到三个培训目标的支持：1)二元干预发展的高级定性方法；2)二元干预改进的混合方法(结合离职访谈定性数据和后评估前量化数据)；3)二元心身RCT方法论。我的多学科指导团队由Ana-Maria Vranceanu博士领导，Ana-Maria Vranceanu博士是临床健康心理学家，也是开发和改进二元心理身体干预的专家，Michael Donnino博士和Sarah Perman博士分别是急诊内科医生和CA临床试验和CA结果研究方面的专家。我的培训目标得到了1)忠诚的、多学科的导师的支持，2)马萨诸塞州综合医院和哈佛医学院丰富的机构环境，3)有针对性的课程、健康公平和多样化培训、研讨会和研讨会、科学会议和体验式学习。我的建议符合NCCIH的优先事项：“支持互补性和综合性健康方法的有效临床试验。”影响：我是一名临床心理学研究员，致力于提高CA的存活率。这个K23是我成为一名独立资助的研究员的第一步，以改善CA和最终的重症监护生存能力。这款K23将为RT-CA的未来试验铺平道路，包括适应不同文化背景的双胞胎、没有非正式照顾者的幸存者、失去亲人的照顾者和昏迷的CA幸存者的照顾者。RT-CA通过提供身心技能和资源来应对生存挑战，有可能为CA创造一个新的护理标准。

PROJECT SUMMARY In this K23 proposal I detail a 5-year training plan that will launch my career as an independent investigator focused on developing and implementing mind-body interventions for cardiac arrest (CA) survivors and their families. Background: Experiencing a CA is continuously traumatic resulting in emotional distress in survivors (up to 61%) and their informal caregivers (up to 40%). Unlike other critically ill populations with established survivorship programs, CA survivor-caregiver dyads (pairs) are under-resourced and unprepared to manage survivorship, which exacerbates emotional distress. Untreated emotional distress post-CA becomes chronic and undermines clinical and quality of life outcomes. Addressing emotional distress early after CA by teaching mind-body skills and providing resources may prevent chronic emotional distress and improve quality of life. Specific aims: I plan to develop, refine, and test the feasibility and acceptability of a dyadic mind-body intervention for CA survivors with good neurologic recovery and their informal caregivers (“Recovering Together after Cardiac Arrest;” RT-CA). My aims are three-fold: 1) develop RT-CA through evidence-based frameworks (dyadic interdependence, response shift framework, family strength vulnerability model, resilience as a process) and evidence-based skills (from cognitive behavior therapy, dialectical behavior therapy, acceptance and commitment therapy, and mindfulness-based stress reduction), input from interviews with CA survivor-caregiver dyads (N=~12 dyads), and focus groups and interviews with CA medical stakeholders (N=16-24 stakeholders); 2) refine RT-CA through an open pilot (N=5 dyads) with exit interviews (for feedback) and pre-post assessments (for initial feasibility and acceptability); 3) test RT-CA for feasibility and acceptability (N=42 dyads) through a pilot randomized clinical trial (RCT) of RT-CA compared to a minimally enhanced usual control. Training: My research aims are supported by three training goals: 1) advanced qualitative methods for dyadic intervention development; 2) mixed methods for dyadic intervention refinement (integrating exit interview qualitative data with pre-post assessment quantitative data); 3) dyadic mind-body RCT methodology. My multi-disciplinary mentorship team is led by Dr. Ana-Maria Vranceanu, a clinical health psychologist and expert in developing and refining dyadic-mind body interventions, and Drs. Michael Donnino and Sarah Perman, emergency medicine physicians and experts in CA clinical trials and CA outcomes research respectively. My training goals are supported by 1) committed, multi-disciplinary mentors, 2) a rich institutional environment at Massachusetts General Hospital and Harvard Medical School, and 3) targeted coursework, health equity and diversity trainings, seminars and workshops, scientific meetings, and experiential learning. My proposal is in line with the NCCIH priority of “supporting impactful clinical trials of complementary and integrative health approaches.” Impact: I am a clinical psychology fellow committed to improving CA survivorship. This K23 is my first step towards becoming an independently funded investigator in improving CA and eventually critical care survivorship. This K23 will pave the way for future trials of RT-CA, including adaptations for culturally diverse dyads, survivors without informal caregivers, bereaved caregivers, and caregivers of comatose CA survivors. RT-CA has the potential to create a new standard of care for CA by providing mind-body skills and resources to cope with survivorship challenges.