Pathways, a Hope-Based Intervention to Support Personal Goal Pursuit, Mental Health, and Quality of Life during Advanced Lung Cancer Treatment

Pathways，一种基于希望的干预措施，支持晚期肺癌治疗期间的个人目标追求、心理健康和生活质量

• 批准号: 10736668
• 负责人: Laurie McLouth
• 金额: $ 54.76万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-25 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736668
• 关键词: Address; Adult; Advanced Malignant Neoplasm; Affect; Age; Anxiety; Attention; Behavioral Sciences; Cancer Burden; Cancer Center; Cancer Patient; Cancer Survivorship; Caregivers; Caring; Clinical; Clinical Trials; Community Clinical Oncology Program; Data; Diagnosis; Distress; Effectiveness; Effectiveness of Interventions; Family; Feedback; Friends; Future; Goals; Health Care Costs; Health Personnel; Immunotherapy; Impairment; Incidence; Infusion procedures; Intervention; Intervention Trial; Kentucky; Leisures; Life; Malignant neoplasm of lung; Mediating; Mediator; Medical; Medical Oncology; Mental Health; Methods; Mind; Mission; National Cancer Institute; Normalcy; Nurses; Occupational Therapist; Outcome; Palliative Care; Pathway interactions; Patient Care; Patients; Performance Status; Persons; Population; Poverty; Premature Mortality; Psychology; Psychosocial Assessment and Care; Public Health; Quality of life; Randomized; Reporting; Research; Resource-limited setting; Role; Rural; Social Functioning; Social Workers; Subgroup; Telephone; Testing; Thinking; Toxic effect; Treatment Efficacy; Underserved Population; Universities; Update; Work; acceptability and feasibility; anxiety symptoms; cancer care; cancer therapy; care delivery; clinical practice; community setting; depressive symptoms; design; effectiveness trial; efficacy evaluation; efficacy testing; efficacy trial; end of life; evidence base; follow-up; health related quality of life; improved; innovation; intervention delivery; intervention effect; male; novel; palliative; patient population; primary outcome; psychological distress; psychosocial; randomized trial; reduce symptoms; residence; response; routine care; satisfaction; sex; skills; social; socioeconomic disadvantage; survivorship; theories; therapy design; treatment as usual; treatment response

ABSTRACT The psychosocial care of patients with advanced lung cancer (ALC) has not kept pace with current medical treatments, creating significant gaps in care. Treatments like immunotherapy have radically changed ALC care, yielding less toxicity and unprecedented increases in 5-year survival. However, mental health and quality of life concerns persist, which must be addressed to fully realize the survival benefits of these medical advancements. To meet the needs of patients in this new treatment context, psychosocial and palliative care for ALC must shift from a predominant end-of-life framework to one of survivorship. A hope-based intervention to support patients’ goal pursuits in their family, social, work, and leisure lives is a promising approach to support mental health and quality of life in this current context. The long-term goal of this research is to improve ALC patient mental health and quality of life during cancer treatment. The overall objective in this application is to test the efficacy of a novel psychosocial intervention called “Pathways” to support personal goal pursuit during ALC treatment. The central hypothesis is that Pathways will reduce goal disruption and thereby improve mental health and quality of life during ALC treatment. The rationale for this project is that Pathways, a brief, hope-based intervention delivered primarily at the point of ALC patient care by a range of healthcare providers (e.g., nurse, occupational therapist, social worker) has demonstrated feasibility and acceptability to ALC patients, with encouraging preliminary effects on goal disruption, mental health, and quality of life outcomes. The central hypothesis will be tested through two specific aims: 1) Test the efficacy of Pathways against enhanced usual care; and 2) Evaluate goal interference and goal adjustment as mediators of intervention effects. Because ALC disproportionately affects rural, older underserved populations who have been underrepresented in psychosocial intervention trials, Aim 3 will use mixed-methods to evaluate the reach and effectiveness of the Pathways intervention among these subgroups. To accomplish these aims, 234 patients undergoing treatment for ALC at the University of Kentucky Markey Cancer Center will be randomized to Pathways or enhanced usual care, with outcomes collected, pre, post, and at follow-up. The research proposed in this application is innovative because it is testing a novel intervention with respect to intervention focus and intervention delivery at the point of ALC care. The proposed research is significant because it will determine the efficacy of an intervention that is responsive to patients’ needs in the current medical landscape for ALC and has high potential for broad dissemination into routine ALC care in both high- and low-resourced settings. Once efficacy is demonstrated, the effectiveness of the intervention will be tested in both academic and community oncology practices with other advanced cancer patient populations, significantly advancing psychosocial and palliative care in this new treatment era and ultimately having a large impact on the over 600,000 people living with advanced cancer in the U.S.

摘要