A Psychosocial Intervention to Improve Outcomes for Parents with Advanced Cancer

摘要 癌症是美国抚养子女的父母过早死亡的主要原因。家长 有先进癌症经验的人心理痛苦深重，许多人没有做好充分准备 与他们进行性疾病和死亡相关的决定和后果。然而，没有有效的方法 为减轻这些患者的心理痛苦而进行的干预。拟议的研究解决了这一关键问题 GAP：我们将开发和试行一种理论指导的心理社会干预，为患有晚期疾病的父母量身定做 癌症和他们的共同父母(一起作为二人组)以减少他们的心理痛苦和改善临终关怀 (停产)准备。我们将首先开发干预-心理治疗咨询访问结构，以 利用关键利益相关者访谈，促进关于育儿问题的二元沟通，然后进行 一项随机对照试验(RCT)，包括60名转移性乳腺癌患者的母亲和她们的共同父母(和 由患者指定的成年人担任孩子(任)--S的主要照顾者(如果她无法接手)。 具体的研究目标是：(1)开发一种独特的、量身定制的心理社会干预措施，以减少心理 转移性乳腺癌母亲及其共同父母的痛苦；和(2)评估可行性， 在试点随机对照试验中，干预效果的可接受性和初步证据。我们假设 改善关于育儿问题和EOL准备的二元沟通将减少患者和联合 父母的抑郁和焦虑。根据医院的测量，主要结果是心理痛苦 焦虑和抑郁量表，用于患者和共同父母。次要结果是二元通信 质量、育儿问题、EOL准备-定义为医疗保健决策的高级护理规划和 养育子女和生活质量。结果将在基线、4周、8周和12周(干预后)进行测量。 Park医生是一名精神病学家，在心理肿瘤学方面接受过高级培训，其长期目标是发展和 测试心理社会干预以改善受父母晚期疾病影响的患者和家庭的结局 癌症。她这个奖项的短期职业目标是：(1)获得教育和实践培训 设计理论指导的、以家庭为中心的肿瘤学心理社会干预措施；(2)获得教育和 培训以设计、实施和评估心理社会干预的随机对照试验；(3)在 实施科学将熟练地设计和测试实用和可持续的心理社会 肿瘤学干预措施；以及(4)开发必要的专业知识、试点数据和出版记录 独立调查员。北卡罗来纳大学的导师和研究培训资源创造了一个理想的环境 获得这个职业发展奖。Park博士致力于作为一名内科科学家的研究生涯，她 是唯一有资格进行这项研究的人，因为她的研究重点是精神病学、肿瘤学 和姑息治疗。这一奖项为Park博士提供了必要的教育、经验培训和飞行员 为未来的大型随机对照试验提供数据，以实现她的长期目标。 1

ABSTRACT Cancer is a leading cause of premature death for parents of dependent children in the United States. Parents with advanced cancer experience profound psychological suffering and many are inadequately prepared for the decisions and consequences associated with their progressive illness and death. Yet there are no effective interventions to reduce psychological distress for these patients. The proposed study addresses this critical gap: we will develop and pilot test a theory-guided psychosocial intervention tailored for parents with advanced cancer and their co-parents (together as a dyad) to reduce their psychological distress and improve end-of-life (EOL) preparation. We will first develop the intervention—psychotherapy counseling visits structured to promote dyadic communication about parenting concerns, using key stakeholder interviews, and then conduct a randomized controlled trial (RCT) with 60 mothers with metastatic breast cancer and their co-parents (an adult identified by the patient to serve as the child(ren)’s primary caregiver if she were to become unavailable). Specific research aims are: (1) to develop a unique, tailored psychosocial intervention to reduce psychological distress in mothers with metastatic breast cancer and their co-parents; and (2) to evaluate the feasibility, acceptability and preliminary evidence for efficacy of the intervention, in a pilot RCT. We hypothesize that improved dyadic communication about parenting concerns and EOL preparation will reduce patients’ and co- parents’ depression and anxiety. The primary outcome is psychological distress, measured by the Hospital Anxiety and Depression Scale, in patients and co-parents. Secondary outcomes are dyadic communication quality, parenting concerns, EOL preparation - defined as advance care planning for healthcare decisions and parenting, and quality of life. Outcomes will be measured at baseline, 4-, 8-, and 12-weeks (post-intervention). Dr. Park is a psychiatrist with advanced training in psycho-oncology whose long-term goal is to develop and test psychosocial interventions to improve outcomes for patients and families affected by parental advanced cancer. Her short-term career goals for this award are to: (1) obtain education and hands-on training in the design of theory-guided, family-centered psychosocial interventions in oncology; (2) obtain education and training to design, conduct, and evaluate RCTs of psychosocial interventions; (3) acquire education in implementation science to become skilled in the design and testing of pragmatic and sustainable psychosocial interventions in oncology; and (4) develop the expertise, pilot data, and publication record necessary to be an independent investigator. The mentorship and research training resources at UNC create an ideal environment for this career development award. Dr. Park is committed to a research career as a physician scientist and she is uniquely qualified to conduct this study given her research focus on the intersection of psychiatry, oncology and palliative care. This award provides Dr. Park with the necessary education, experiential training, and pilot data for a future large RCT to achieve her long-term goals. 1