Piloting Pathways, a Hope-Enhancing Intervention to Address Activity and Role Function in Metastatic Lung Cancer Patients

项目摘要 肺癌是第二大最常见的癌症，也是男性癌症死亡的主要原因 近9万人将被诊断为转移性非小细胞肺癌， （NSCLC），占肺癌的40%。肿瘤转移的一个更令人痛苦的后果是 NSCLC对患者的影响是其对患者参与日常活动和角色的影响。肺的40-65%之间 癌症患者报告说，他们日常活动和角色的损害是最大的未满足的支持性护理需求。 这种护理差距反映在现有的干预措施中，这些措施没有直接解决功能问题，而且效果不佳。 纳入初级肿瘤护理。这项研究的总体目标是通过以下方式解决这一护理差距： 实施支持性护理干预，以帮助解决小学生的活动和角色功能问题 肿瘤护理。我们的研究表明，干预病人的希望，这反映了机构的追求 目标和确定实现目标的途径，可能是解决活动和作用的一种有希望的方法， 转移性NSCLC患者的功能问题。根据我们的初步数据，我们的多学科团队 已经调整了一种用于转移性NSCLC患者初级肿瘤治疗的增强肿瘤免疫的干预措施。 干预，所谓的途径，是基于希望理论，包括5个会议，旨在帮助 患者确定有意义和可行的目标，以追求和增加患者的代理和途径， 在可能存在疾病障碍的情况下追求目标，包括肺癌的耻辱感。述干预 由受过支持性护理培训的护士通过面对面和电话会议提供。研究 本申请中提出的方法将评估路径的可行性。在目标1中，我们将通过以下方式完善路径： 在6名转移性NSCLC患者中进行试点，并与他们进行访谈，以评估其可接受性 并收集需要改进的方面的建议。我们的多学科团队将审查 目标1和优化路径中的信息。然后，在目标2中，我们将测试可行性（患者增加， 依从性、保留率、患者可接受性评级），并评估 希望的前后变化，癌症相关目标干扰，以及与功能和 痛苦这项研究的结果将确定护士提供的增强干预的可行性， 改善在转移性NSCLC患者中的活动和作用，并提供初步数据， 干预效果的随机对照试验。

Project Summary Lung cancer is the second most commonly diagnosed cancer and leading cause of cancer death among men and women in the U.S. Nearly 90,000 people will be diagnosed with metastatic non-small cell lung cancer (NSCLC) this year, representing 40% of lung cancers. One of the more distressing consequences of metastatic NSCLC to patients is its effect on their participation in daily activities and roles. Between 40-65% of lung cancer patients report that impairment in their daily activities and roles is a top unmet supportive care need. This care gap is reflected in existing interventions, which do not directly address function and are not well integrated into primary oncologic care. The overall goal of this research is to address this care gap by implementing a supportive care intervention to help address activity and role function concerns in primary oncologic care. Our research suggests that intervening on patient hope, which reflects agency for pursuing goals and identifying pathways to pursue goals, may be a promising approach to address activity and role function concerns in metastatic NSCLC patients. Informed by our preliminary data, our multidisciplinary team has adapted a hope-enhancing intervention for use with metastatic NSCLC patients in primary oncologic care. The intervention, called Pathways, is based in Hope Theory and comprised of 5 sessions designed to help patients identify meaningful and feasible goals to pursue and increase patient agency and pathways for pursuing goals in the presence of likely disease obstacles, including lung cancer stigma. The intervention is delivered by a nurse with training in supportive care through in-person and phone sessions. The research proposed in this application will evaluate the feasibility of Pathways. In Aim 1, we will refine Pathways by piloting it with 6 metastatic NSCLC patients and conducting interviews with them to evaluate its acceptability and gather suggestions for aspects that need to be improved. Our multidisciplinary team will review the information from Aim 1 and refine Pathways. Then, in Aim 2, we will test the feasibility (patient accrual, adherence, retention, patient acceptability ratings) of Pathways with 20 metastatic NSCLC patients and assess pre-post changes in hope, cancer-related goal interference, and outcome measures related to function and distress. Results of this study will determine the feasibility of a nurse-delivered hope-enhancing intervention to improve function in activities and roles in metastatic NSCLC patients and provide preliminary data to inform a randomized controlled trial of efficacy of the intervention.