Coping with Breast Cancer and Treatment: An E-Learning Course for Skills and Stra

描述(由申请人提供)：认知行为压力管理(CBSM)干预已被证明在乳腺癌治疗期间可以减少与癌症相关的痛苦，促进情绪发展和改善免疫功能。CBSM干预使用经过充分验证的认知行为技术，如放松和冥想训练、认知结构调整和沟通技能训练，以提高积极、适应的应对能力，并通常在小组环境中提供。本项目旨在为接受早期乳腺癌辅助治疗的妇女开发CBSM干预的在线版本。第一阶段的成就包括开发用户界面和网络干预的两个原型模块。这两个模块(“放松入门”和“与医疗保健提供者的沟通”)是用Talaria的专有软件创建的，具有很强的互动性，并以多媒体格式呈现。两项可用性研究，一项是面对面的，另一项是在线的，对62名当前和过去的癌症患者进行了研究，结果表明，患者的认可度、满意度和易用性都很高。在第二阶段，目标是开发整个干预措施，并在随机临床试验中检查其有效性。这一10个模块的干预将包括由Talaria经验丰富的电子学习团队由临床医生、研究人员、作家、程序员和多媒体专家组成的适用于网络演示的认知行为技术。每个模块将包括自我评估和有针对性的反馈、授课心理教育、互动练习和自我监测的机会--所有这些都是为早期乳腺癌患者的需求量身定做的。此外，指导性的书面自我表露练习将促进情感表达，讨论板将鼓励团队支持。这种基于网络的干预将进行可用性测试，最终产品将在随机临床试验中进行评估，样本为120名乳腺癌辅助治疗女性。妇女将被随机分配使用为期10周的干预措施，同时进行两周一次的电话评估，或者只进行电话评估。结果测量包括患者对自己应对能力的信心、受益发现、生活质量和与癌症相关的痛苦。我们计划将该产品直接销售给癌症患者，以及癌症护理提供者、医院、诊所和生产抗癌药物的制药公司。公共卫生相关性：每年有近20万名美国妇女被诊断出患有乳腺癌。在接受癌症治疗的过程中，由于压力、治疗副作用、焦虑、抑郁和人际关系困难，许多患者的生活质量显著下降。我们建议开发一个基于网络的认知行为压力管理版本，这是一种针对乳腺癌女性的经验性干预措施。这种网络干预将是方便的、私人的，无论妇女在哪里或保险覆盖范围内，都可以以低成本获得。

DESCRIPTION (provided by applicant): Cognitive Behavioral Stress Management (CBSM) interventions have been shown to decrease cancer-related distress, foster emotional growth and improve immune functioning during treatment for breast cancer. CBSM interventions use well-validated cognitive behavioral techniques such as relaxation and meditation training, cognitive restructuring, and communication skills training to increase active, adaptive coping and are typically delivered in a group setting. The present project aims to develop an online version of a CBSM intervention for women undergoing adjuvant treatment for early stage breast cancer. Phase I achievements included developing the user interface and two prototype modules of the web-based intervention. These two modules ("Introduction to Relaxation" and "Communication with Healthcare Providers") were created with Talaria's proprietary software, are highly interactive, and are presented in a multimedia format. Two usability studies, one in- person and one online, with 62 current and past cancer patients, demonstrated high levels of approval, satisfaction, and ease-of-use. In Phase II goals are to develop the entire intervention and examine its effectiveness in a randomized clinical trial. This 10-module intervention will consist of cognitive behavioral techniques adapted for web-presentation by Talaria's experienced eLearning team of clinicians, researchers, writers, programmers and multimedia experts. Each module will include self- assessment and targeted feedback, didactic psychoeducation, interactive exercises, and opportunities for self-monitoring-- all tailored to the needs of women with early stage breast cancer. In addition, guided written self-disclosure exercises will promote emotional expression and a discussion board will encourage group support. The web-based intervention will be usability tested and the final product will be evaluated in a randomized clinical trial with a sample of 120 women in adjuvant treatment for breast cancer. Women will be randomly assigned to use the 10-week intervention with biweekly telephone assessments or to the telephone assessments alone. Outcome measures include patients' confidence in their coping abilities, benefit finding, quality of life, and cancer-related distress. We plan to market this product directly to cancer patients, as well as to cancer care providers, hospitals, clinics and pharmaceutical companies that manufacture cancer medications. Public Health Relevance: Nearly 200,000 American women are diagnosed with breast cancer every year. As they go through cancer treatment, many patients experience a significant decline in their quality of life due to stress, treatment side effects, anxiety, depression, and relationship difficulties. We propose to develop a web-based version of Cognitive Behavioral Stress Management, an empirically supported intervention for women with breast cancer. This web intervention will be convenient, private and available for low cost to women regardless of location or insurance coverage.