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 疼痛影响了大约三分之二的晚期癌症患者，其发生率接近90% 生命的终结。尽管药物治疗对于缓解慢性癌症疼痛至关重要，但心理上的 这些因素对疼痛的结果也有很大影响。疼痛认知行为疗法(CBT)是 对慢性癌症和非恶性疼痛有效。不幸的是，传统格式的Pain-CBT(60- 12-16周的面对面会议)对晚期癌症患者来说是不现实的。有效 生物-心理-社会癌症疼痛管理需要实质性的适应，以满足现实生活中 治疗晚期癌症患者，理想情况下应与药物治疗支持相结合。给出了广阔的 需要，移动医疗技术是一种很有前途的战略，可以提供并最终传播简短、痛苦-CBT 对癌症患者的干预。 我们的目标是通过适应和整合疼痛-CBT来提高晚期癌症患者的疼痛自我管理 纳入我们现有的mHealth计划，旨在支持患者的药理学管理。我们的父母 干预，STAMP(智能手机技术缓解恶性疼痛)是一款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，并提供定制的疼痛心理教育和 建议。我们拥有调整和整合Pain-CBT以创建新的mHealth干预的战略机遇 这协调了对晚期癌症疼痛的心理和医学支持。利用移动技术， 我们将通过以下方式模拟疼痛-CBT的治疗体验：1)呈现先进的针对癌症的多媒体 心理教育内容，2)制定每天提供简短教学的时间表，3)促进洞察力 通过调查和量身定制的反馈来构建，以及4)通过游戏化的认知来激发主动学习 重组练习和录音放松。目标1：我们将补充我们的多媒体资料库 癌症疼痛心理教育和适应疼痛-针对针对晚期患者的简短mHealth交付的CBT内容 癌症，同时将临床医生和患者(n=20)的反馈贯穿始终。在AIM 2：25名慢性阻塞性肺病患者 晚期癌症疼痛患者将使用STAMP+CBT治疗6周。调查结果将阐明应用程序使用的可行性 并为更大的未来疗效试验(R01)收集数据，允许探索疼痛的有意义的趋势， 心理调停者和护理利用。如果被证明有效，这种疼痛-CBT和阿片类药物治疗 干预具有巨大的潜力，可以扩大并使生物-心理-社会疼痛治疗适用于以下人群 患有不成比例的慢性疼痛，几乎没有机会进行非药物疼痛治疗 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.