Home-Based Tablet Computer Pain Coping Skills Following Stem Cell Transplant

描述（由申请人提供）：持续性疼痛是接受造血干细胞移植（HSCT）的患者面临的主要挑战，与更多疲劳、更多身体残疾、更差的生活质量和更差的医疗依从性有关。有必要研究HSCT患者疼痛管理策略，以补充现有的镇痛方案。强有力的证据表明，认知和行为因素在HSCT患者管理疼痛的能力中起着重要作用。我们已经发现具有低水平置信度的HSCT患者（即，自我效能）在他们控制疼痛的能力和高度使用适应不良的应对策略（即，疼痛灾难化）经历增加的疼痛和残疾。心理社会干预，修改患者的认知和行为疼痛应对策略可能有利于HSCT患者。已经开发了方案，特别是疼痛应对技能培训（PCST），用于减轻持续性疼痛患者的疼痛并改善其生活质量。然而，HSCT持续性疼痛患者面临着许多独特的挑战，在应用PCST方案时必须考虑这些挑战。我们建议为持续性疼痛的HSCT患者开发和测试移动的健康疼痛应对技能（mPCST）协议，以满足HSCT患者疼痛的挑战，因为他们从医院为基础的护理过渡到他们的家庭环境。本研究的第一个目的是使用迭代开发模型为HSCT患者设计mPCST干预方案，其目标是增加疼痛控制的自我效能和减少疼痛灾难化。我们将与患者和HSCT提供者一起使用焦点小组来指导开发，沿着HSCT患者疼痛的用户测试。本研究的第二个目的是使用一项小型随机对照试验来检查已开发的mPCST方案的可行性、可接受性和参与度。第三个目的是获得与标准护理对照条件相比，所开发的mPCST方案对疼痛减轻、疼痛残疾、身体残疾和遵守受疼痛影响的移植后生活方式建议的效应量估计值。将开发的mPCST方案的拟议创新功能包括：PCST和HSCT专家以及HSCT疼痛患者的广泛输入;出院前的初始会议，随后通过视频会议在家中进行;纳入减少疼痛对遵守关键移植后生活方式建议的影响的策略;实时每日评估系统，随后提供定制反馈。如果 所开发的mPCST方案证明了可行性、可接受性、参与性和有希望的影响疼痛和其他生活质量指数的效应量，将寻求更大的NIH拨款以在更大的患者样本中检查该方案，针对积极治疗测试该方案，并调查更广泛的结果（例如，药物依从性）。这种mPCST方案也可以在面临类似挑战的其他疼痛患者人群中进行检查（例如，住得离医疗中心很远，旅行受限）。

DESCRIPTION (provided by applicant): Persistent pain is a major challenge for patients who undergo hematopoietic stem cell transplant (HSCT) and is related to more fatigue, more physical disability, poorer quality of life, and poorer medical adherence. There is a need to examine strategies for managing pain in HSCT patients that can complement existing analgesic regimens. Strong evidence suggests that cognitive and behavioral factors play an important role in HSCT patients' ability to manage their pain. We have found that HSCT patients having low levels of confidence (i.e., self-efficacy) in their ability to control pain and high use of maladapive coping strategies (i.e., pain catastrophizing) experience increased pain and disability. A psychosocial intervention that modifies patients' cognitive and behavioral pain coping strategies may benefit HSCT patients. Protocols, particularly Pain Coping Skills Training (PCST), have been developed for reducing pain and improving quality of life in patients with persistent pain. However, HSCT patients with persistent pain face a number of unique challenges that must be considered when applying a PCST protocol. We propose to develop and test a Mobile Health Pain Coping Skills (mPCST) protocol for HSCT patients with persistent pain to meet the challenges of HSCT patients with pain as they transition from hospital based care to their home environment. The first aim of this study is to use an iterative development model to design a mPCST intervention protocol for HSCT patients that targets increasing self-efficacy for pain control and decreasing pain catastrophizing. We will use focus groups with patients and HSCT providers to guide development along with user testing with HSCT patients having pain. The second aim of this study is to use a small randomized controlled trial to examine the feasibility, acceptability, and engagement in the developed mPCST protocol. The third aim is to obtain an estimate of the effect size of the developed mPCST protocol on decreased pain, pain disability, physical disability, and adherence to post-transplant lifestyle recommendations impacted by pain when compared to a standard care control condition. Proposed innovative features of the mPCST protocol that will be developed include: extensive input from PCST and HSCT experts and HSCT patients with pain; an initial session prior to discharge with subsequent sessions occurring at home via video-conferencing; incorporation of strategies to decrease the impact of pain on adherence to critical post-transplant lifestyle recommendations; a real-time daily assessment system with subsequent tailored feedback. If the developed mPCST protocol demonstrates feasibility, acceptability, engagement, and promising effect sizes to influence pain and other indices of quality of life, a larger NIH grant wll be sought to examine this protocol in a larger sample of patients, test the protocol against an active treatment, and investigate a broader array of outcomes (e.g., medication adherence). This mPCST protocol could also be examined in other patient populations with pain facing similar challenges (e.g., live far from medical center, travel limitations).