A Decision Aid for Cancer-Surviving Adolescents

描述(申请人提供)：物质使用可能改变癌症幸存青少年的健康状况，放大放射和化疗的后遗症，并导致肺、心血管和肝脏异常。青少年癌症幸存者正在艰难地决定是像他们的同龄人一样从事危险行为，还是听从他们健康专家的建议。2003年儿童肿瘤学小组迟发效应筛查指南解决了危险行为咨询的必要性。决策辅助帮助患者做好准备，做出与他们的健康状况相关的决定。 这项研究的目的是：1)检验这样一种假设，即接受决策援助(认知-行为技能计划)以增强决策技能(框架在风险行为及其与癌症治疗晚期影响的背景下)的青少年癌症幸存者在干预后6个月和12个月比通常护理组报告更高质量的决策；2)探索这样的假设：与常规护理组相比，接受决策援助的青少年癌症幸存者将在干预后6个月和12个月报告(A)保持或降低风险动机，以及(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个月使用重复测量。三家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。240名14-19岁的青少年癌症幸存者将被招募。将使用两个小组：那些报告在研究开始时至少参与了一种危险行为的人和那些没有参与研究的人。青少年将通过连续登记从诊所时间表中选择，并随机分配到每个小组中的两个小组(通常或加强护理)之一。结果测量为：决策、风险动机和风险行为状态。在最初的访问期间，将执行决策辅助，然后在2、4和6个月时为计算机邮寄三个回家的“电子助推器”。9个月后将使用电话保持联系。所有后续行动都将通过电话进行监控。所有测量将在所有3个端点在线完成，认知量表除外，它只在一次情况下以纸质形式完成。数据将在最初和12个月的诊所就诊的半结构化访谈中收集。数据分析将使用广义线性模型。

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.