Pilot trial testing mobile health psychosocial intervention for Adolescentsand Young Adults with cancer

项目总结/文摘

PROJECT SUMMARY/ABSTRACT In addition to coping with their medical illness, Adolescents and Young Adults (AYAs) with cancer struggle with the age-related developmental challenges of independence, education, employment, relationships, and identity. AYAs with cancer are at high risk of poor short-term and long-term outcomes, including poor mental health, social isolation, risky health behaviors, unemployment, and poor quality of life. With the rapid rise in digital technologies, skills-based psychosocial interventions are increasingly deployed via mobile health (mHealth) platforms. Such interventions show promising treatment effects, help overcome barriers to traditional in-person delivery models, and are highly appealing to AYAs. However, mHealth interventions focused on improving quality of life and psychosocial outcomes have not yet been successfully evaluated or implemented among AYA cancer patients. This application builds on my prior work with the "Promoting Resilience in Stress Management" (PRISM) intervention for AYAs with cancer. This novel, brief, evidence-based 1:1 intervention teaches stress management, goal-setting, meaning making, cognitive-behavioral, and mindfulness strategies. I and my team have adapted this in-person intervention to a self-guided mHealth intervention, mPRISM. This mixed-methods proposal has the following 3 complementary aims: (Aim 1) To evaluate the feasibility, acceptability, and exploratory efficacy of mPRISM for AYAs with cancer in a pilot randomized trial; (Aim 2) To analyze backend digital usage patterns in order to identify and target aspects of digital engagement associated with improvement in psychosocial outcomes; and, (Aim 3) To assess barriers and facilitators to the adoption of mHealth interventions in clinical settings via semi-structured exit interviews with patient and clinic stakeholders. This proposal has technological, methodological, and dissemination innovations in potential for scale-up of interventions to overcome structural barriers to psychosocial treatment access. This K08 will provide opportunities to acquire skills and knowledge in: advanced clinical trials research as PI; mHealth research including intervention testing, digital analytics, and strategies to optimize engagement and adoption; and advanced implementation science methods. The research and career development plan, supported by a multi- disciplinary team of experts (in AYA oncology, implementation science, mHealth and mobile analytics, clinical trials research, advanced statistics, and qualitative methods) and in a rich academic environment, will support the PI’s transition to an independent clinical-scientist who possesses the skills and expertise to use cutting- edge mobile health methods to promote the implementation of evidence-based care for AYA oncology patients. This proposal will inform the design of the PI’s large-scale multi-site hybrid effectiveness-implementation trial of mPRISM (R01 proposal). Aligned with the NCI’s priorities, this program of research will promote evidence- based behavioral interventions that improve quality of life, the utilization of portable low-cost technologies to expand access to care, and implementation science initiatives to bridge the research-practice gap.