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

 描述（由申请人提供）：音乐疗法，一种常用的艺术疗法，已成为许多儿科和成人医院的标准姑息治疗;然而，很少有研究探讨音乐疗法干预工作的机制。基于音乐治疗的情境支持模型，我们开发并测试了积极音乐参与（AME）干预，将其确立为一种可行且可接受的干预措施，可减少因癌症住院治疗的幼儿（3-8岁）的情绪困扰。患有癌症的幼儿在急性治疗期间及其父母的情绪困扰是一种普遍存在的持续性问题，与身体症状困扰和生活质量下降和家庭功能有关。音乐治疗师主导的AME使用基于音乐的游戏和家长教育/支持（音乐游戏资源包;提示表），易于实施，并教导家长/儿童如何治疗性地使用熟悉的活动来管理痛苦。这项两组随机对照试验的目的是确定在以前的AME研究中观察到的有助于积极结果的行为、社会学和心理学变量（即，调解人）并识别干预对谁起作用（即，主持人）。我们将研究近端介质的儿童参与和亲子互动和远端介质的感知家庭正常，父母的信心（自我效能），他们的能力，以支持他们的孩子在治疗期间，和独立的父母/儿童使用音乐播放来管理住院期间的困扰。我们假设这些因素介导了儿童情绪困扰，身体症状困扰和生活质量的结果的变化;父母的情绪/创伤困扰和生活质量;和家庭功能。具体目标是审查：1）AME近端和远端介质对幼儿/父母结局的影响; 2）AME对幼儿/父母痛苦的调节剂; 3）在调节和调节模型中探索儿童身体症状痛苦（疼痛、疲劳、恶心）。儿童/父母二人组（n=184）将按年龄分层，并随机分为6个区组，分别接受AME或注意力控制;每组将接受3次45分钟的治疗，由有资格的音乐治疗师连续3天进行治疗，并在基线、干预后和30天后收集数据。将使用ANCOVA估计中介效应，使用MPlus拟合适当的中介模型，然后使用百分位数自助法测试间接效应，以估计间接效应。调节效应将通过在我们的模型中包括潜在调节者与干预指标的适当相互作用项来进行测试。随后的研究将检查AME在反复住院治疗，以管理痛苦和预防创伤应激症状的生存。

 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.