Addressing Social Needs of Adolescents and Young Adults (AYAs) with Cancer

项目摘要 患有癌症的青少年和年轻人（AYAs）面临着社会心理和生活质量不良的高风险。 癌症可能带来风险的一种方式是通过损害社会支持，这是心理社会健康的一个强有力的预测因素。 AYA高度重视家人、朋友和其他AYA患者的支持。然而，许多患有癌症的AYA感到 被孤立，并报告他们的关系在治疗期间紧张，导致长期的社会支持 缺陷尽管有既定的需求，但针对AYA社会支持需求的方案很少。的那些 缺乏理论基础或发展剪裁。目前的研究使用了一种新的方法来解决这些问题 通过调整以证据为基础的、多成分的支持性护理计划来满足目标社会关系的需求 应对效能（SRCE）。被定义为一个人的感知能力，以维持或加强密切的关系，在 在疾病的背景下，SRCE是一个新的结构，具有强大的理论基础，与AYAs的 发展需要。支持SRCE将使AYAs能够管理与癌症相关的关系挑战， 寻求和保持支持性的关系，从而缓冲癌症对感知的负面影响。 支持.此外，在促进压力管理复原力（PRISM）计划中， 基于技能的AYA弹性干预与成功的适应历史，将使这一成功 工作和以后传播的潜力。基于初步数据并遵循肥胖相关 行为干预试验（ORBIT）模式的行为干预发展，本研究的第一阶段 (K99，2年）旨在完善PRISM+SRCE适应。具体而言，本阶段的目标是（1） 使用AYA（n≥12）利益相关者反馈迭代地改进SRCE组件内容;（2）改进实践方面 PRISM+SRCE联合项目，包括使用AYA的交付、培训和保真度监测（n=15） 和PRISM干预者（n=3）利益相关者反馈;以及（3）制定最终干预手册并交付 议定书此外，K99活动将提供应用的机会，以补充学习目标， 有前途的早期职业行为科学家，包括发展定性研究方法的专业知识， 临床试验设计和实施的概念和实践方面的培训。第二，独立阶段 本研究（R 00，3年）的目的是建立这种适应的概念验证。通过一个两个地点的随机- 在N=100名新诊断为癌症的AYA中进行的对照试验，该阶段的目标是（1）确定可行性 PRISM+SRCE项目的可接受性;（2）探索PRISM+SRCE是否能改善心理社会 与常规护理相比。这项研究的结果将为随后的（R 01资助的） III期疗效试验的这种适应。本项目符合癌症RFA-CA-20-057的目标 控制科学领域，旨在加强应用行为干预，以改善AYA的生活质量。如果 如果成功的话，这一调整将改善AYA的社会成果，并加强PRISM的整体影响 计划，从而创造了一个有前途的范例，全面解决AYA的心理社会需求。

PROJECT SUMMARY Adolescents and young adults (AYAs) with cancer are at high risk for poor psychosocial and quality of life outcomes. One way cancer may confer risk is through compromising social support, a robust predictor of psychosocial wellbeing. AYAs highly value support from family, friends, and other AYA patients. However, many AYAs with cancer feel isolated and report that their relationships are strained during their treatment, resulting in long term social support deficiencies. Despite established demand, few programs targeting AYA social support needs exist. Those that do lack theoretical bases or developmental tailoring. The current study uses a novel approach to address these needs by adapting an evidence-based, multicomponent supportive care program to target social relationship coping efficacy (SRCE). Defined as one’s perceived ability to maintain or enhance close relationships in the context of illness, SRCE is a new construct with a strong theoretical basis that is well aligned with AYAs’ developmental needs. Bolstering SRCE will enable AYAs to manage cancer-related relational challenges and seek and maintain supportive relationships, thereby buffering the negative impact of cancer on perceived support. Moreover, targeting SRCE within the Promoting Resilience in Stress Management (PRISM) program, a skill based AYA resilience intervention with a history of successful adaptation, will enable the success of this work and potential for later dissemination. Building on preliminary data and following the Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral intervention development, the first phase of this study (K99, 2 years) aims to refine the PRISM+SRCE adaptation. Specifically, the goals of this phase are to (1) iteratively refine SRCE component content using AYA (n≥12) stakeholder feedback; (2) refine practical aspects of the combined PRISM+SRCE program including delivery, training, and fidelity monitoring using AYA (n=15) and PRISM interventionist (n=3) stakeholder feedback; and (3) develop a final intervention manual and delivery protocol. Additionally, K99 activities will provide applied opportunities to complement the learning goals of a promising early career behavioral scientist, including developing expertise in qualitative research methods and training in conceptual and practical aspects of clinical trial design and conduct. The second, independent phase of this study (R00, 3 years) aims to establish proof-of-concept of this adaptation. Through a two-site randomized- controlled trial of N=100 AYAs newly diagnosed with cancer, the goals of this phase are to (1) establish feasibility and acceptability of the PRISM+SRCE program; and, (2) explore whether PRISM+SRCE improves psychosocial outcomes compared to usual care. Findings from this study will critically inform a subsequent (R01-funded) Phase III efficacy trial of this adaptation. This project fulfills the objectives of RFA-CA-20-057 in the Cancer Control Science area by aiming to enhance an applied behavioral intervention to improve AYA quality of life. If successful, this adaptation will both improve AYA social outcomes and bolster the overall impact of the PRISM program, thus creating a promising paradigm for comprehensively addressing AYA psychosocial needs.