Mechanisms of Active Music Engagement to Improve Health Outcomes of Children with Cancer and Parents

 描述(申请人提供)：音乐疗法，一种经常使用的以艺术为基础的疗法，已经成为许多儿科和成人医院的标准姑息治疗；然而，很少有研究检验音乐疗法干预的作用机制。基于音乐疗法的情境支持模型，我们开发并测试了主动音乐参与(AME)干预，将其确立为一种可行且可接受的干预措施，以减轻因癌症住院治疗的幼儿(3-8岁)的情绪困扰。癌症儿童及其父母在急性治疗期间的情绪困扰是一个普遍而持久的问题，与身体症状困扰、生活质量下降和家庭功能下降有关。由音乐治疗师领导的AME使用以音乐为基础的游戏和家长教育/支持(音乐游戏资源包；提示表)，易于实施，并教父母/孩子如何通过治疗使用熟悉的活动来应对痛苦。这两组随机对照试验的目的是确定对先前AME研究中观察到的积极结果有贡献的行为、社会学和心理变量(即中介)，并确定干预对谁起作用(即主持人)。我们将考察儿童参与和亲子互动的近端中介，以及感知到的家庭正常的远端中介，父母对他们在治疗期间支持孩子的能力的信心(自我效能)，以及父母/孩子独立使用音乐游戏来处理住院期间的痛苦。我们假设这些因素在儿童情绪困扰、身体症状困扰和生活质量、父母情绪/创伤性痛苦和生活质量以及家庭功能的结果变化中起中介作用。具体目的是考察：1)AME的近端和远端中介对幼儿/父母结局的影响；2)AME对幼儿/父母痛苦的调节作用；3)在中介和调节模型中探索儿童的身体症状困扰(疼痛、疲劳、恶心)。儿童/父母二元组(n=184)将按年龄分层，并随机分成6个区组至AME或注意力控制组；每组将接受三次45分钟的治疗，连续3天与有资质的音乐治疗师交谈，数据收集在基线、干预后和30天后。将使用ANCOVA估计调解效果，使用MPlus拟合适当的调解模型，然后使用百分位数自举方法测试间接影响以估计间接影响。在我们的模型中，我们将通过包括潜在主持人与干预指标的适当交互作用来测试缓和效果。随后的研究将通过反复住院来检查AME，以管理痛苦并预防生存过程中的创伤应激症状。

 DESCRIPTION (provided by applicant): Music therapy, a frequently used arts-based therapy, has become standard palliative care in many pediatric and adult hospitals; however, few studies have examined mechanisms by which music therapy interventions work. Based on the Contextual Support Model of Music Therapy, we developed and tested the Active Music Engagement (AME) intervention, establishing it as a feasible and acceptable intervention that reduces emotional distress in young children (ages 3-8) hospitalized for cancer treatment. Emotional distress in young children with cancer during acute treatment and their parents is a prevalent, persistent problem associated with physical symptom distress and diminished quality of life and family function. The music therapist-led AME uses music-based play and parent education/support (music play resource kit; tip sheets), is easy to implement, and teaches parents/children how to therapeutically use a familiar activity to manage distress. The purpose of this two group randomized controlled trial is to identify behavioral, sociological, and psychological variables contributing to positive outcomes observed in previous AME studies (i.e., mediators) and identify for whom the intervention works (i.e., moderators). We will examine proximal mediators of child engagement and parent- child interaction and distal mediators of perceived family normalcy, parent confidence (self-efficacy) about their ability to support their child during treatment, and independent parent/child use of music play to manage distress during hospitalization. We hypothesize these factors mediate change in outcomes of child emotional distress, physical symptom distress, and quality of life; parent emotional/ traumatic distress and quality of life; and family function. Specific aims are to examine: 1) effects of proximal and distal mediators of AME on young child/parent outcomes; 2) moderators of AME on young child/parent distress; 3) explore child physical symptom distress (pain, fatigue, nausea) in mediation and moderation models. Child/parent dyads (n=184) will be stratified by age and randomized in blocks of 6 to AME or attention control; each group will receive three 45-minute sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention, and 30 days later. Mediation effects will be estimated using ANCOVA, fitting appropriate mediation models using MPlus and then testing indirect effects using the percentile bootstrap approach to estimate indirect effect. Moderation effects will be tested by including appropriate interaction terms of the potential moderator with the intervention indicator in our models. Subsequent studies will examine AME across repeated hospitalizations to manage distress and prevent traumatic stress symptoms in survivorship.