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

摘要 晚期肺癌患者的心理社会护理没有跟上现代医学的步伐。 治疗，在护理方面造成了巨大的差距。免疫疗法等疗法从根本上改变了ALC的治疗， 毒性更小，5年存活率史无前例地增加。然而，心理健康和生活质量 担忧依然存在，必须解决这一问题，以充分实现这些医疗保健的生存好处 进步。为了满足患者在这种新的治疗背景下的需求，心理社会和姑息治疗 因为ALC必须从主要的生命终结框架转变为生存框架。基于希望的干预 支持患者在家庭、社交、工作和休闲生活中的目标追求是一种很有前途的方法 在当前的背景下支持心理健康和生活质量。这项研究的长期目标是 在癌症治疗期间改善ALC患者的心理健康和生活质量。这个项目的总体目标是 应用是测试一种被称为“路径”的新型心理社会干预的有效性，以支持个人 ALC治疗过程中的目标追求。中心假设是路径将减少目标干扰和 从而改善ALC治疗期间的心理健康和生活质量。这个项目的基本原理是 路径，这是一种简短的、基于希望的干预措施，主要在ALC患者护理时提供，由一系列 医疗保健提供者(例如护士、职业治疗师、社会工作者)已经证明了可行性和 对肌萎缩侧索硬化症患者的可接受性，在目标中断、心理健康和 生活质量结果。中心假设将通过两个具体目标进行检验：1)检验 2)评估目标干扰和目标调整作为目标调整的中介变量 干预效果。因为ALC对农村老年人的影响不成比例，这些老年人没有得到足够的服务 在心理社会干预试验中，目标3的代表性不足，将使用混合方法来评估REACH 以及在这些亚组中进行路径干预的有效性。为实现这些目标，234 在肯塔基大学马基癌症中心接受ALC治疗的患者将被随机分组 到路径或增强的日常护理，收集结果，在治疗前、治疗后和随访时。这项研究 在本申请中提出的是创新的，因为它针对干预测试一种新的干预 肌萎缩侧索硬化症护理的焦点和干预交付。这项拟议的研究意义重大，因为它将 确定在当前医疗环境中响应患者需求的干预措施的有效性 对于ALC，并有很高的潜力广泛传播到高资源和低资源的常规ALC护理中 设置。一旦有效性被证明，干预的有效性将在两个学术领域进行测试 和其他晚期癌症患者群体的社区肿瘤学实践，显著推进 心理社会和姑息治疗在这个新的治疗时代，并最终对结束 美国有60万晚期癌症患者。

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.