Leveraging mHealth to deliver integrated pain-CBT, opioid monitoring, and self-management support for advanced cancer patients coping with chronic pain

项目摘要 疼痛影响大约三分之二的晚期癌症患者，接近90%的比例接近100%。 生命终结尽管药物治疗对于缓解慢性癌症疼痛至关重要，但心理治疗 这些因素也显著影响疼痛结果。疼痛的认知行为疗法（CBT） 对慢性癌症和非恶性疼痛有效。不幸的是，疼痛CBT在其传统的格式（60- 分钟，12-16周的面对面治疗）对于晚期癌症患者是不现实的。有效 生物心理社会癌症疼痛管理需要大量的适应，以满足现实生活的需要， 晚期癌症患者，理想情况下应结合药物治疗支持。鉴于广阔的 需要，移动的健康技术是一个有前途的战略，提供并最终传播简短的，痛苦的CBT 对癌症患者的干预。 我们的目标是通过调整和整合疼痛-CBT来改善晚期癌症患者的疼痛自我管理 我们现有的移动健康项目旨在支持患者的药物管理。子公司 STAMP（智能手机技术，以减轻恶性疼痛）是一种面向患者的智能手机， 支持日常症状和阿片类药物监测的应用程序，并提供量身定制的疼痛心理教育， 建议.我们有一个战略机会来适应和整合疼痛CBT，以创造新的移动健康干预 协调对晚期癌症疼痛的心理和医疗支持。利用移动的技术， 我们将通过以下方式模拟疼痛-CBT的治疗体验：1）展示先进的癌症特异性多媒体 心理教育内容，2）制定时间表，每天提供简短的教学，3）促进洞察力 通过调查和量身定制的反馈进行建设，以及4）通过游戏化的认知刺激主动学习 重组工作和录音放松。在目标1：我们将补充我们的多媒体图书馆， 癌症疼痛心理教育和适应疼痛CBT内容为简短的移动健康交付特定于先进的 癌症，同时整合临床医生和患者（n=20）的反馈。目标2：25例慢性 晚期癌症的疼痛将使用STAMP+CBT 6周。调查结果将阐明应用程序使用的可行性 以及为更大规模的未来疗效试验（R 01）收集数据，以便探索疼痛的有意义趋势， 心理中介和护理利用。如果证明有效，这种疼痛CBT和阿片类药物管理 干预有很大的潜力来扩大规模，使生物心理社会疼痛治疗可用于人口， 不成比例地患有慢性疼痛，并且几乎无法获得非药物疼痛管理 治疗。

Project Summary Pain affects approximately two thirds of patients with advanced cancer, with rates approaching 90% near the end-of-life. Although pharmacotherapy is vitally important to alleviating chronic cancer pain, psychological factors also substantially influence pain outcomes. Cognitive Behavioral Therapy for pain (pain-CBT) is effective for chronic cancer and non-malignant pain. Unfortunately, pain-CBT in its traditional format (60- minute, in-person sessions for 12-16 weeks) is unrealistic for advanced cancer patients. Effective biopsychosocial cancer pain management requires substantial adaptation to meet the real-life needs of advanced cancer patients and should ideally integrate with pharmacotherapy support. Given the expansive need, mobile health technology is a promising strategy to deliver and ultimately disseminate brief, pain-CBT interventions to cancer patients. Our goal is to improve advanced cancer patients' pain self-management by adapting and integrating pain-CBT into our existing mHealth program designed to support patients' pharmacologic management. Our parent intervention, STAMP (Smartphone Technology to Alleviate Malignant Pain) is a patient-facing smartphone application that supports daily symptom and opioid monitoring, and delivers tailored pain psychoeducation and advice. We have a strategic opportunity to adapt and integrate pain-CBT to create novel mHealth intervention that harmonizes psychological and medical support for advanced cancer pain. Leveraging mobile technology, we will simulate the therapeutic experience of pain-CBT by 1) presenting advanced cancer-specific, multimedia psychoeducational content, 2) developing schedules to deliver daily, brief didactics, 3) facilitating insight building via surveys and tailored feedback, & 4) stimulating active learning through gamified cognitive restructuring exercises and audio-recorded relaxations. In Aim 1: We will supplement our multi-media library of cancer pain psycho-education and adapt pain-CBT content for brief mHealth delivery specific to advanced cancer, while integrating clinician and patient (n=20) feedback throughout. In Aim 2: 25 patients with chronic pain from advanced cancer will use STAMP+CBT for 6 weeks. Findings will illuminate feasibility of app use and data collection for a larger future efficacy trial (R01), allowing for exploration of meaningful trends in pain, psychological mediators, and care utilization. If proven effective, this pain-CBT and opioid management intervention has great potential to scale and make biopsychosocial pain treatment available to a population that suffers disproportionately from chronic pain and has little access to non-pharmacologic pain management treatments.