A Presurgery Hypnosis Training Program for Nurse Anesthetists

描述（由申请人提供）：手术是目前所有治疗乳腺癌的重要组成部分。绝大多数女性在保乳手术后会经历非常令人厌恶的副作用，包括疼痛，恶心和疲劳。手术治疗的这些副作用的负面后果反映在多个公共卫生领域，包括这些妇女遭受的痛苦，以及医疗机构和整个社会承担的财务费用。 为了解决这一重要的临床和公共卫生问题，我们开发并建立了一个简短的，术前，心理医生管理的催眠干预乳腺癌患者的有效性。在200名乳腺癌手术患者的样本中，这种干预措施显着减少了疼痛，恶心和疲劳，并为该机构节省了每位患者727美元的成本。这表明，如果在全国范围内对所有乳腺癌手术患者常规使用术前催眠，每年将节省超过1.4亿美元的医疗保健费用。 不幸的是，从研究方案到标准临床护理的药物支持行为医学干预的记录是糟糕的。新干预措施翻译失败的常见原因是缺乏训练有素的人员和费用。为了促进术前催眠的常规使用，以改善病人护理，我们计划实施和评估一个新的培训计划。具体来说，与R25E计划公告一致，我们计划培训麻醉护士，以循证方法控制症状和副作用，即催眠干预。收集成本效益数据是设计的一个重要部分，因为这些数据是促进培训方案在供资期结束后继续下去的关键，而且这些数据将为决策者提供经验证据。此外，我们将在学术和公立医院培训护士，因为学术环境的进步往往不能转化为社区。项目评估将集中在三个层面：护士对培训材料的学习，催眠干预的表现，以及护士麻醉师管理的催眠干预在降低机构成本和患者术后副作用方面的有效性（使用随机临床试验设计进行评估）。 目的一：为麻醉科护士提供术前催眠训练。 目的2：从最终使用者（患者）的角度检验术前催眠训练计划的有效性。 目的3：从机构（医院）的角度探讨催眠训练计划的相对有效性。

DESCRIPTION (provided by applicant): Surgery is an essential part of all current treatments to cure breast cancer. The vast majority of women will experience highly aversive side effects following breast conserving surgery, including pain, nausea, and fatigue. The negative consequences of these side effects of surgical treatment are reflected in multiple public health domains including the suffering these women endure, as well as the financial costs borne by medical institutions and thereby society at large. To address this important clinical and public health problem, we developed and established the effectiveness of a brief, presurgery, psychologist-administered hypnosis intervention for breast cancer patients. This intervention significantly reduced pain, nausea and fatigue in a sample of 200 breast cancer surgical patients, and additionally resulted in a cost savings to the institution of $727 per patient. This indicates that If presurgery hypnosis were routinely used with all breast cancer surgical patients on a national basis, over $140 million health care dollars would be saved each year. Unfortunately, the track record of empirically-supported behavioral medicine interventions making the jump from research protocol to standard clinical care is abysmal. Common reasons given for the failure of the translation of new interventions are the unavailability of trained personnel and cost. To promote the routine use of presurgery hypnosis to improve patient care, we plan to implement and evaluate a new training program. Specifically, consistent with the R25E program announcement, we plan to train nurse anesthetists in our evidence-based approach to symptom and side effect control, namely in our hypnosis intervention. Collecting cost-effectiveness data is an important part of the design, as such data are key to promoting the continuation of the training program beyond conclusion of the funding period, and as such data will provide empirical evidence to decision makers. Furthermore we will train nurses in both academic and public hospitals, as too often advances at academic settings do not translate to the community. Program evaluation will focus on three levels: nurses' learning of the training material, their performance of the hypnosis intervention, and the effectiveness of the nurse anesthetist-administered hypnosis intervention in reducing institutional costs and patients' postsurgery side effects (assessed using a randomized clinical trial design). Aim 1: To develop and implement a training program in presurgery hypnosis for nurse anesthetists. Aim 2: To examine the effectiveness of the presurgery hypnosis training program from the perspective of end-users (patients). Aim 3: To investigate the relative effectiveness of the hypnosis training program from the perspective of the institution (hospitals).