A Randomized Controlled Trial using a Heuristic Tool To Improve Symptom Self-Management in Adolescents and Young Adults with Cancer

项目摘要 在美国，每年约有90，000名青少年和年轻人（AYAs）被诊断患有癌症。 States.患有癌症的AYA会经历多种疾病的并发症和相关症状， 治疗对他们的日常生活产生不利影响，难以自我管理。因为管理不善 症状降低生活质量，增加症状严重程度和痛苦，有效的以人为本 症状自我管理（SS-M）对于患有癌症的AYA至关重要。然而，一个主要障碍是缺乏 针对这一人群的有效症状自我管理干预措施。拟定研究 通过测试旨在改善患有癌症的AYA的SS-M行为的干预措施来解决这一差距， 正在积极治疗中计算机化症状捕获工具（C-SCAT）是一种使用 促进AYA的自我意识和对自己及其症状的洞察力的方法， 帮助他们想象他们独特症状经历的“大画面”。这一使用与 典型的症状评估检查表方法，不包括患者的观点， 识别高优先级症状，定义为对他们最重要的症状，以及 症状之间的相互关系。C-SCAT还帮助AYA讨论症状问题， 对他们来说，与临床医生共同制定有效的SS-M计划至关重要。本研究 是一项两组多中心随机对照试验，其中126名接受积极治疗的癌症AYA将 随机分配到C-SCAT干预组或常规护理对照组。具体目标是：1） 确定C-SCAT与常规护理对症状自我效能主要结局的影响 干预后即刻（时间1）和随访时的症状管理和症状自我管理行为- 1个月后（时间2）; 2）检查C-SCAT与常规护理对次要结局的影响 （症状严重程度、症状困扰、社会功能和社会功能满意度） 干预（时间1）和一个月后的随访（时间2）;和3）探索个体的关系， 因素和健康的社会决定因素与症状管理和症状自我效能， 本研究的长期目标是减轻症状， AYAs通过支持症状自我管理在癌症治疗期间经历的。如果显示为 有效的，C-SCAT可以被纳入临床环境，并可能纳入电子健康记录 作为一种有效的，低成本的方法来改善症状自我管理。

PROJECT SUMMARY Approximately 90,000 adolescents and young adults (AYAs) are diagnosed with cancer yearly in the United States. AYAs with cancer experience multiple co-occurring and related symptoms from their disease and treatment that adversely affect their day-to-day lives and are difficult to self-manage. Because undermanaged symptoms reduce quality of life and increase symptom severity and distress, effective person-centered symptom self-management (SS-M) is imperative for AYAs with cancer. A major barrier, however, is a lack of effective symptom self-management interventions that are tailored to this population. The proposed study addresses this gap by testing an intervention designed to improve SS-M behaviors in AYAs with cancer who are in active treatment. The Computerized Symptom Capture Tool (C-SCAT) is an intervention that uses a heuristics approach to promote AYAs’ self-awareness and insight about themselves and their symptoms and help them visualize the ‘big picture’ of their unique symptom experience. This use of heuristics contrasts with typical checklist approaches to symptom assessment which do not incorporate the patient’s perspective to identify symptoms of high priority, defined as the symptoms that are most important to them, and interrelationships among symptoms. The C-SCAT also facilitates AYAs in discussing the symptom issues that are of greatest importance to them with a clinician and jointly developing an effective plan for SS-M. This study is a two-group multi-site randomized controlled trial in which 126 AYAs with cancer in active treatment will be randomly assigned to the C-SCAT intervention group or usual care control group. The specific aims are to: 1) Determine the effects of the C-SCAT versus usual care on the primary outcomes of self-efficacy for symptom management and symptom self-management behaviors immediately post intervention (Time 1) and at follow- up one month later (Time 2); 2) Examine the effects of the C-SCAT versus usual care on secondary outcomes (symptom severity, symptom distress, social function, and satisfaction with social function) immediately post intervention (Time 1) and at follow-up one month later (Time 2); and 3) Explore the relationships of individual factors and social determinants of health with self-efficacy for symptom management and symptom self- management behaviors at baseline (Time 0).The long-term goal of this research is to mitigate the symptoms that AYAs experience during cancer treatment by supporting symptom self-management. If shown to be effective, the C-SCAT could be incorporated into clinical settings and possibly into the electronic health record as an efficient, low-cost approach to improve symptom self-management.