Cancer Pain Management: A Technology-Based Intervention for Asian American Breast Cancer Survivors

由于乳腺癌的文化污名，对疼痛和症状的文化斯多葛主义，以及语言 障碍，亚裔美国乳腺癌幸存者往往遭受不必要的痛苦，这可能是很容易的 使用现有的药理学或非药理学策略进行管理。尤其是亚裔美国人的乳房 有抑郁症状(ABD)的癌症幸存者更有可能因疼痛管理不足而 疼痛会进一步加重他们的抑郁。此外，最近的阿片类药物危机 加剧了他们对上瘾的恐惧和不愿为疼痛控制寻求帮助。COVID19大流行也给这一特定人群带来了额外的压力。然而，癌症中心的生存计划缺乏工作人员和时间来充分满足这一人群的这些独特需求。使用计算机和移动设备的基于技术的方法有望以高效率满足这一需求 灵活性、可访问性和匿名性。在初步研究(PSS)的基础上，研究小组开发了 试点测试基于循证Web App的癌症疼痛信息和指导/支持计划 管理(CAPA)是为亚裔美国乳腺癌幸存者量身定做的文化，使用多个 独特的功能。然而，CAPA在其设计或设计中很少考虑伴随疼痛的抑郁症状 构成部分，PSS表明有必要进一步使干预构成部分个人化。 由于ABD的需求不同，CAPA的需求也不同。拟议的两阶段研究的目的是进一步 开发带有ABD和个人优化功能(CAI)的附加组件的CAPA，并 测试计算机辅助教学对改善ABD患者癌痛体验的效果。具体目标是：a)发展 并通过专家评审和可用性测试(R61阶段)对计算机辅助教学进行评估；b)确定 干预组(使用计算机辅助教学和日常护理)的改善程度将显著高于积极干预组 对照组(使用CAPA和常规护理)主要结果(癌症疼痛管理和癌症 疼痛经历，包括抑郁症状)从基线到1个月后和3个月后；c)确定 以理论为基础的变量(态度、自我效能、感知障碍和社会影响)调节 计算机辅助教学对初级结果的干预作用；以及d)决定计算机辅助教学是否对儿童的学习成绩产生影响。 主要结果受选定的背景、疾病、遗传和环境因素的影响。本研究 以班杜拉理论以及拉撒路和福克曼的压力和应对框架为指导。R61 阶段包括：(A)干预开发过程；(B)在15个ABD、15个家庭中进行可用性测试 (C)对10名肿瘤学专家进行一次专家审查。R33 各期采用随机重复措施对照组设计，共300例。长期目标是： (A)在具有ABD不同亚群的不同保健环境中推广和测试计算机辅助教学，(B)审查成本- 计算机辅助教学在环境中的有效性、可持续性和可扩展性，以及(C)将计算机辅助教学转化为ABD的卫生保健。

Due to cultural stigma attached to breast cancer, cultural stoicism toward pain and symptoms, and language barriers, Asian American breast cancer survivors tend to suffer unnecessarily from pain that could be easily managed using existing pharmacologic or non-pharmacologic strategies. Especially, Asian American breast cancer survivors with depressive symptoms (ABD) are more likely to have inadequate pain management due to their depression, and pain could further deteriorate depression. Furthermore, the recent opioid crisis has exacerbated their fear of addiction and reluctance to seek help for pain management. The COVID19 pandemic has also placed an additional dimension of stress to this specific population. However, survivorship programs at cancer centers lack the staff and time to adequately address these unique needs of this population. A technology-based approach using computers and mobile devices promises to meet this necessity with high flexibility, accessibility, and anonymity. Based on Preliminary Studies (PSs), the research team developed and pilot-tested an evidence-based Web App-based information and coaching/support program for cancer pain management (CAPA) that was culturally tailored to Asian American breast cancer survivors using multiple unique features. However, CAPA rarely considered depressive symptoms accompanying pain in its design or components, and PSs indicated the necessity of further individualization of the intervention components of CAPA due to diversities in the needs of ABD. The purpose of the proposed 2-phase study is to further develop CAPA with additional components for ABD and the individual optimization functionality (CAI) and to test the efficacy of CAI in improving cancer pain experience of ABD. The specific aims are to: a) develop and evaluate CAI through an expert review and a usability test (R61 phase); b) determine whether the intervention group (that uses CAI and usual care) will show significantly greater improvements than the active control group (that uses CAPA and usual care) in primary outcomes (cancer pain management and cancer pain experience including depressive symptoms) from baseline to post 1-month and post 3-months; c) identify theory-based variables (attitudes, self-efficacy, perceived barriers, and social influences) that mediate the intervention effects of CAI on the primary outcomes; and d) determine whether the effects of CAI on the primary outcomes are moderated by selected background, disease, genetic, and situational factors. This study is guided by the Bandura’s Theory and the stress and coping framework by Lazarus and Folkman. The R61 phase includes: (a) the intervention development process, (b) a usability test among 15 ABD, 15 family members, and 15 community gatekeepers; and (c) an expert review among 10 experts in oncology. The R33 phase adopts a randomized repeated measures control group design among 300 ABD. Long-term goals are: (a) to extend and test CAI in various healthcare settings with diverse subgroups of ABD, (b) examine the cost- effectiveness, sustainability, and scalability of CAI in the settings, and (c) translate CAI into health care for ABD.