Adherence to the HCT Medical Regimen: Influence of Cancer Patient-Cargiver Dyads

Donna Posluszny博士的职业目标是开发一个独立的研究项目，专注于设计和评估新的行为和心理干预措施，以提高癌症患者-家庭护理人员二人组坚持复杂的医疗方案和改善患者身体健康结果的能力。Posluszny博士是医学助理教授和临床心理学家，通过提供癌症医疗方案研究方面的培训，为实现这一目标迈出了必要的第一步;癌症依从性研究领域的行为和心理干预发展;以及对患者和家庭护理人员进行纵向和干预性临床研究的方法。具体而言，五年培训计划包括（1）正式课程;（2）导师和顾问的定期指导;（3）参加研讨会，讲习班和国家会议;（4）指导研究;（5）临床实践。Posluszny博士的临床培训，她的指导团队的专业知识，以及匹兹堡大学医学院和匹兹堡大学癌症研究所的研究环境相结合，将促进拟议的培训计划和研究的成功实施。该研究计划致力于实施一个独立的项目，以评估患者和家庭护理人员在造血干细胞移植（HCT）后前100天内对复杂的多组分HCT的依从性，以及基于问题解决疗法原则的以患者-护理人员二元为中心的心理教育干预的开发和试点，以增强对HCT后医疗方案的依从性。具体目标是（1）调查患者和护理人员如何划分与出院后坚持多组分HCT后医疗方案相关的责任;（2）确定与不坚持HCT后医疗方案相关的发生率、关键风险因素和患者健康结局;和（3）开发和初步评估一个试点的病人-照顾者二元集中的心理教育干预，旨在减少不遵守后HCT的医疗方案。该应用程序解决了美国国家癌症研究所的持续承诺，制定举措，以了解家庭在癌症经历中的作用，并改善患者的健康结果，并在其坚持的二元重点是独一无二的。总的来说，本研究的结果将促进识别适应性和非适应性的二元方法，以遵守HCT后的医疗方案，并提供基础和初步数据的心理教育干预，以提高HCT患者及其家庭照顾者的依从性，从而改善患者的健康结果。

DESCRIPTION (provided by applicant): Dr. Donna Posluszny's career goal is to develop an independent research program focused on designing and evaluating novel behavioral and psychosocial interventions to enhance cancer patient-family caregiver dyads' ability to adhere to complex medical regimens and improve patient physical health outcomes. The K23 award will enable Dr. Posluszny, who is an Assistant Professor of Medicine and a clinical psychologist, to take the necessary first steps towards this goal by providing training in medical regimen research in cancer; behavioral and psychosocial intervention development in the field of adherence research in cancer; and methodologies for conducting and analyzing longitudinal and interventional clinical research with patient and family caregiver dyads. Specifically, the five-yer training plan includes (1) formal coursework; (2) regular mentoring from mentors and consultants; (3) participation in seminars, workshops, and national conferences; (4) mentored research; and (5) clinical practice. The combination of Dr. Posluszny's clinical training, the expertise of her mentoring team, and the research environment of the University of Pittsburgh School of Medicine and University of Pittsburgh Cancer Institute will facilitate the successful implementation of the proposed training plan and research study. The research plan is devoted to the implementation of an independent project to evaluate patient and family caregiver adherence to the complex, multicomponent post- hematopoietic stem cell transplantation (HCT) during the first 100 days post HCT and the development and piloting of a patient-caregiver dyad-focused psychoeducational intervention, grounded in the principles of Problem-Solving Therapy, to enhance adherence to the post-HCT medical regimen. Specific aims are (1) investigation of how patients and caregivers divide the responsibilities associated with adherence to the multicomponent post-HCT medical regimen post-hospital discharge; (2) determination of rates of, key risk factors for, and patient health outcomes associated with nonadherence to the post-HCT medical regimen; and (3) development and preliminary evaluation of a pilot patient-caregiver dyad-focused psychoeducational intervention designed to decrease nonadherence to the post-HCT medical regimen. This application addresses the National Cancer Institute's continuing commitment to developing initiatives to understand the role of family in the cancer experience and improve patient health outcomes, and is unique in its dyadic focus on adherence. Collectively, the outcomes of this study will foster the identification of both adaptive and nonadaptive dyadic approaches to adherence to the post-HCT medical regimen and provide the groundwork and preliminary data for a psychoeducational intervention to improve adherence for HCT patients and their family caregivers, and thereby improve patient health outcomes.