Giving and receiving: A reciprocal support writing intervention to reduce symptoms during stem cell transplant

到2030年，干细胞移植(主要用于血液病)的使用预计将增加5倍，届时 幸存者人数将达到50万人。这种剧毒的治疗会导致一系列的急性体力和 心理症状(如疼痛、疲倦、痛苦)持续数年的患者高达45%。至 解决现有针对症状的行为干预措施中的空白，这些干预措施可以添加到标准的患者护理中， 我们开发了表情帮助(EH)，这是一种低成本、低负担的干预措施，目标是一系列体力活动 以及广泛的移植受者的心理症状。EH包括两个治疗成分， 在4周的4个简短的结构化写作会议中完成：3个Pennebaker的情感会议 表现性写作之后进行一次基于理论和证据的“同伴支持”写作，患者 使用富有表现力的写作中的洞察力来描述他们的移植经历 共享以帮助准备或接受移植的人。在随机对照试验(RCT)中比较 在长期移植幸存者中，EH减少了躯体症状和痛苦 有中度至重度持续性症状的幸存者。因为大多数患者的症状都会上升为 他们接受了移植，早期症状预示着持续的症状，我们现在建议确定 在移植过程中是否可以使用EH来减少常见的急性症状和预防 持续的症状。此外，EH被设计为互补的、由两部分组成的“互惠利益”的一部分 基于患者可以从获得体验式体验中获益的证据的“帮助”干预策略 从其他患者的同伴支持叙述和通过以下方式提供同伴支持的移植信息 正在完成EH。因此，我们建议开始开发和评估基于Web的支持性 为准备和接受移植的患者提供来自EH的同伴支持叙述的资源。因此， 在目标1中，我们建议进行一项双臂随机对照试验，以评估高血压在术后早期使用的疗效。 移植时期。参与者将是315名至少有中度症状的癌症患者，招募预先 移植并随机分配到EH或中性书写(NW)时间和注意力控制组。他们将完成 从入院第一周到出院后两周的指定写作，并被跟踪12周- 几个月来评估症状负担(主要结果)和心理困扰、生活质量、 和绩效状况(次要结果)。在目标2中，我们将评估潜在的干预机制 (理论化的因果路径)和主持人。在目标3中，我们将开发和评估用于 在数据的指导下，从EH向准备或接受移植的患者提供同行支持描述 来自试验参与者、由关键利益相关者、焦点小组和可用性测试组成的社区顾问委员会。 这一建议的综合方法是新颖的，并有望成为一种可传播和临床相关的 减少干细胞移植受者急性和持续性症状的干预策略。

Use of stem cell transplant (mostly for hematologic cancers) is expected to increase 5-fold by 2030, when the number of survivors will reach 500,000. This highly toxic treatment causes a range of acute physical and psychological symptoms (e.g., pain, fatigue, distress) which then persist for years for up to 45% of patients. To address gaps in existing symptom-focused behavioral interventions that can be added to standard patient care, we developed Expressive Helping (EH), a low-cost, low-burden intervention that targets a range of physical and psychological symptoms in a broad group of transplant recipients. EH includes 2 therapeutic components, completed in 4 brief structured writing sessions over 4 weeks: 3 sessions of Pennebaker’s emotionally expressive writing followed by 1 session of theory- and evidence-based “peer support” writing in which patients use insights from expressive writing to write an account of their transplant experience that is meant to be shared to help people preparing for or undergoing transplant. In a randomized controlled trial (RCT) comparing EH to 3 active control arms in long-term transplant survivors, EH reduced physical symptoms and distress in survivors with moderate to severe persistent symptoms. Because symptoms are elevated for most patients as they undergo transplant, and early symptoms predict persistent symptoms, we now propose to determine whether EH can be used during transplant to reduce common acute symptoms and prevent development of persistent symptoms. Further, EH was designed to be part of a complementary, 2-part “reciprocal benefits of helping” intervention strategy based on evidence that patients can benefit both from getting experiential information about transplant from other patients’ peer support narratives and from providing peer support by completing EH. We therefore propose to begin development and evaluation of a web-based supportive resource to deliver peer support narratives from EH to patients preparing for and undergoing transplant. Thus, in Aim 1 we propose to conduct a 2-arm RCT to evaluate the efficacy of EH when used in the early post- transplant period. Participants will be 315 cancer patients with at least moderate symptoms, recruited pre- transplant and randomized to EH or a neutral writing (NW) time and attention control arm. They will complete their assigned writing from the first week of hospitalization to 2 weeks post-discharge and be followed for 12- months to evaluate effects on symptom burden (primary outcome) and psychological distress, quality of life, and performance status (secondary outcomes). In Aim 2 we will evaluate potential intervention mechanisms (theorized causal pathways) and moderators. In Aim 3 we will develop and evaluate optimal methods for delivering peer support narratives from EH to patients preparing for or undergoing transplant, guided by data from trial participants, a community advisory board of key stakeholders, focus groups, and usability testing. This proposed integrated approach is novel and holds promise as a disseminable and clinically-relevant intervention strategy for reducing acute and persistent symptoms in stem cell transplant recipients.