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

癌症疼痛管理：针对亚裔美国乳腺癌幸存者的基于技术的干预措施

• 批准号: 10595357
• 负责人: Wonshik Chee
• 金额: $ 74.42万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10595357
• 关键词: Address; Adopted; Analgesics; Asian Americans; Attitude; Biological Markers; Breast Cancer Risk Factor; Breast Cancer survivor; COVID-19 pandemic; Cancer Center; Cancer Pain Management; Cancer Patient; Cancer Survivor; Chinese; Chronic; Communities; Computer software; Computers; Control Groups; Data; Devices; Dimensions; Disease; East Asian; Ethnic Origin; Family history of; Family member; Fatigue; Fright; Gatekeeping; Genetic; Goals; Health; Healthcare; Individual; Institute of Medicine (U.S.); Internet; Intervention; Intervention Studies; Japanese; Koreans; Language; Malignant Neoplasms; Measures; Mediating; Mental Depression; Methods; Modality; Oncology; Operating System; Outcome; Outcome Study; Pain; Pain management; Patient Self-Report; Pharmacology; Phase; Population; Prevalence; Process; Quality of life; Race; Randomized; Relative Risks; Reporting; Research; Running; Self Efficacy; Sleep disturbances; Stigmatization; Stoicism; Stress; Stress and Coping; Subgroup; Survival Rate; Survivors; Symptoms; Technology; Testing; Time; Translating; Translations; Work; active control; addiction; authority; base; cancer pain; chronic pain; cost effectiveness; cultural competence; depressive symptoms; design; digital; efficacy evaluation; efficacy testing; ethnic disparity; ethnic minority; evidence base; experience; flexibility; follow-up; group intervention; handheld mobile device; health care service; health care settings; health disparity; help-seeking behavior; high risk; improved; innovation; intervention effect; malignant breast neoplasm; opioid epidemic; pain symptom; phase 2 study; pilot test; primary outcome; programs; prototype; racial and ethnic; social health determinants; social influence; social stigma; survivorship; symptom management; theories; therapy development; treatment as usual; usability; web app; web server

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.

由于文化上对乳腺癌的歧视，对疼痛和症状的文化坚忍，以及语言 亚裔美国人乳腺癌幸存者往往遭受不必要的疼痛， 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 患有抑郁症状（ABD）的癌症幸存者更有可能因疼痛管理不足而导致疼痛。 疼痛会进一步恶化抑郁症。此外，最近的阿片类药物危机 加剧了他们对成瘾的恐惧，不愿寻求疼痛管理的帮助。COVID-19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足够的人员和时间来满足这一人群的这些独特需求。使用计算机和移动的设备的基于技术的方法承诺以高效率满足这一需求。 灵活性、可访问性和匿名性。基于初步研究（PS），研究团队开发了 对一项基于循证Web App的癌症疼痛信息和指导/支持计划进行了试点测试 管理（CAPA），这是文化上针对亚裔美国人乳腺癌幸存者使用多种 独特的功能。然而，CAPA很少在其设计中考虑伴随疼痛的抑郁症状， 组成部分和PS表明有必要进一步个性化干预组成部分 由于ABD需求的不确定性而采取CAPA。拟议的两阶段研究的目的是进一步 开发CAPA，其中包含ABD和单独优化功能（CAI）的附加组件，并 验证CAI对改善ABD患者癌痛体验的疗效。具体目标是：（a）发展 并通过专家评审和可用性测试（R61阶段）评估CAI; B）确定 干预组（使用CAI和常规护理）将显示出比活动组更大的改善。 对照组（使用CAPA和常规护理）的主要结局（癌痛管理和癌症 从基线到1个月后和3个月后的疼痛经历，包括抑郁症状; c）识别 基于理论的变量（态度，自我效能感，感知障碍和社会影响），介导 CAI对主要结局的干预作用;以及d）确定CAI对主要结局的影响是否 主要结果由选定的背景、疾病、遗传和环境因素调节。本研究 班杜拉理论和拉扎勒斯、福克曼的压力与应对框架是本研究的指导思想。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 成员和15名社区把关人;以及（c）10名肿瘤学专家的专家审查。R33 在300例ABD患者中采用随机重复测量对照组设计。长期目标是： (a)为了在具有不同ABD亚组的各种医疗保健环境中扩展和测试CAI，（B）检查成本- 有效性，可持续性和可扩展性的CAI设置，和（c）翻译CAI到ABD的医疗保健。