Telephone Symptom Management for Advanced Lung Cancer Patients and Caregivers

晚期肺癌患者和护理人员的电话症状管理

• 批准号: 9308871
• 负责人: Catherine E Mosher
• 金额: $ 13.64万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-05 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9308871
• 关键词: Address; Advanced Malignant Neoplasm; Affect; Anxiety; Attention; Behavioral; Behavioral Medicine; Cancer Control; Cancer Intervention; Cancer Patient; Caregivers; Chronic; Clinical; Cognitive; Cognitive Therapy; Communication; Control Groups; Couples; Data; Development Plans; Diagnosis; Disease; Distant; Distress; Dyspnea; Emotions; Ensure; Family Caregiver; Fatigue; Feedback; First Independent Research Support and Transition Awards; Funding; Health; Impairment; Instruction; Intervention; Intervention Trial; Interview; Learning; Length; Lung; Malignant Neoplasms; Malignant neoplasm of lung; Mediating; Mediator of activation protein; Mental Depression; Mentors; Natural History; Outcome; Pain; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Phase; Phonation; Population; Psychological adjustment; Psychosocial Assessment and Care; Quality of life; Randomized; Relaxation; Reporting; Research; Research Methodology; Research Personnel; Resources; Self Efficacy; Severities; Spouses; Symptoms; Target Populations; Technology; Telephone; Testing; Thinking; Training; Travel; United States; Woman; anxiety symptoms; attentional control; base; career; career development; caregiver strain; caregiving; cognitive testing; coping; depressive symptoms; disabling symptom; evidence base; experience; functional status; improved; innovation; men; novel; physical symptom; portability; post intervention; preference; primary outcome; programs; psychological symptom; psychosocial; public health relevance; secondary outcome; skills; social cognitive theory; symptom management; theories

DESCRIPTION (provided by applicant): Lung cancer is frequently advanced at diagnosis, and over 80% of lung cancer patients experience multiple symptoms, such as depression, anxiety, pain, fatigue, and breathlessness, which negatively impact their quality of life. Family caregivers of lung cancer patients also experience high rates of anxiety and depressive symptoms and poor quality-of-life outcomes. This application proposes a program of research and career training focused on improving patient-caregiver dyads' physical and psychological adjustment to lung cancer. The proposed research will further develop and test a novel, dyad-focused telephone symptom management (TSM) intervention with the potential to treat highly prevalent and disabling symptoms in advanced lung cancer patients and their caregivers. The intervention is a blend of evidence-based cognitive-behavioral and emotion- focused strategies that include instruction in relaxation, adaptive thinking and communication skills, and activity planning and pacing. While prior studies have primarily tested cognitive-behavioral interventions to improve patients' and couples' adjustment to early-stage cancer, TSM addresses advanced cancer patients' and caregivers' concerns and combines cognitive-behavioral and emotion-focused approaches. The proposed research includes two phases. In Phase 1, qualitative interviews will be conducted with advanced lung cancer patients and caregivers (N = 24 dyads) to ensure that the intervention is sensitive to the needs and preferences of the target population. The intervention will then be revised based on the qualitative findings. In Phase 2, advanced lung cancer patients who meet established clinical cutoffs for at least one of five symptoms (i.e., depressive symptoms, anxiety, pain, fatigue, or breathlessness) and their family caregivers (e.g., spouse, other relative) who meet clinical cutoffs for depressive symptoms or anxiety (N = 100 dyads) will be randomized to (1) five weekly phone sessions of TSM intervention tailored to patients' and caregivers' symptoms, or (2) five weekly phone sessions of an attention control condition that provides an overview of resources for psychosocial support and health information. Assessments will be administered at baseline and 2 and 6 weeks post-intervention. Brief symptom assessments will also be administered to patients and caregivers during each intervention or control session. Patient outcomes will include symptom control (i.e., depressive symptoms, anxiety, pain, fatigue, breathlessness, and overall symptom burden), functional status, quality of life, and quality of relationship with the caregiver. Caregiver outcomes will include depressive symptoms, anxiety, strain, quality of life, and quality of relationship with the patient. Patient and caregiver self- efficacy for symptom management also will be assessed as potential mediators of the effects of TSM on outcomes. The proposed research has the potential to provide valuable, new information that can aid in selecting strategies for helping advanced lung cancer patients and their family caregivers better manage symptoms. The career development plan includes training in the natural history and clinical aspects of lung cancer and theories and research methods for developing and evaluating technology-based interventions for cancer patient-caregiver dyads. Through a combination of mentored research, coursework, seminars, and directed learning experiences, the applicant will develop the necessary skills for building an independently funded program of research focused on improving patient-caregiver dyads' physical and psychological adjustment to cancer.

描述（由申请人提供）：肺癌在诊断时经常是晚期，超过80%的肺癌患者会出现多种症状，如抑郁、焦虑、疼痛、疲劳和呼吸困难，这些症状会对他们的生活质量产生负面影响。家庭照顾者 的肺癌患者也有很高的焦虑和抑郁症状发生率，生活质量也很差。本申请提出了一个研究和职业培训计划，重点是改善病人照顾者的身体和心理适应肺癌。拟议的研究将进一步开发和测试一种新的，以二分为重点的电话症状管理（TSM）干预，有可能治疗晚期肺癌患者及其护理人员的高度流行和致残症状。该干预措施是一种基于证据的认知行为和以情绪为重点的策略的混合，包括放松、适应性思维和沟通技能以及活动计划和节奏的指导。虽然先前的研究主要测试认知行为干预措施，以改善患者和夫妇对早期癌症的适应，但TSM解决了晚期癌症患者和护理人员的担忧，并结合了认知行为和以情感为中心的方法。拟议的研究包括两个阶段。在第1阶段，将对晚期肺癌患者和护理人员（N = 24对）进行定性访谈，以确保干预措施对目标人群的需求和偏好敏感。然后将根据定性结果对干预措施进行修订。在第2阶段，晚期肺癌患者符合五种症状中至少一种的既定临床截止值（即，抑郁症状、焦虑、疼痛、疲劳或呼吸困难）和他们的家庭护理者（例如，配偶、其他亲属）将被随机分配到（1）针对患者和护理者的症状定制的TSM干预的每周五次电话会议，或（2）提供心理社会支持和健康信息资源概述的注意力控制条件的每周五次电话会议。将在基线以及干预后2周和6周进行评估。在每次干预或对照期间，还将对患者和护理人员进行简要症状评估。患者结局将包括症状控制（即，抑郁症状、焦虑、疼痛、疲劳、呼吸困难和总体症状负担）、功能状态、生活质量和与护理者的关系质量。照顾者的结果将包括抑郁症状、焦虑、紧张、生活质量以及与照顾者的关系质量。 病人患者和护理者对症状管理的自我效能也将作为TSM对结局影响的潜在介质进行评估。这项研究有可能提供有价值的新信息，有助于选择策略，帮助晚期肺癌患者及其家庭护理人员更好地管理症状。职业发展计划包括肺癌的自然史和临床方面的培训，以及为癌症患者-护理人员二人组开发和评估基于技术的干预措施的理论和研究方法。通过指导研究，课程，研讨会和指导学习经验的结合，申请人将开发必要的技能，以建立一个独立资助的研究计划，重点是改善患者-护理人员对癌症的身体和心理适应。