Integrating Palliative Care into Self-Management of Breast Cancer

产品说明：尽管姑息治疗服务的扩散和迅速增长的证据表明，姑息治疗提高生活质量和寿命，患者仍然不了解其性质和好处。姑息治疗是为患有进行性晚期疾病的患者提供的专业医疗护理，可缓解严重疾病的疼痛，症状和压力。本研究的目的是测试心理教育干预，旨在提高患者的姑息治疗的知识，并促进其及时融入自我管理（SM）的乳腺癌。我们的具体目标是：1）评估干预对乳腺癌患者姑息治疗知识的影响; 2）初步考察干预对患者感觉（自我效能、焦虑、抑郁、不确定感）和行为的影响 （护理对话的目标，SM中的角色，沟通技巧，过渡管理，医疗保健利用）;和3）评估拟议方案的可行性和可接受性。一个探索性的目的是调查人口统计学和临床因素在多大程度上缓和干预的效果，重点是少数参与者之间的使用和结果的差异。我们的初步工作表明，干预措施是有效的，在提高姑息治疗和SM转移性乳腺癌患者的知识。这些数据为在R 01机制下进行大型RCT的预期中进行试点RCT提供了强有力的证据。干预措施，管理癌症护理：个人指南（MCC），由七个印刷模块组成：管理您的症状;管理您的护理和设定目标;护理选项;与您的医疗保健提供者交谈;与您的家人和朋友交谈;管理过渡;在不确定性期间自信地行事。这些模块教授日常SM活动，有助于在身体，心理和社会脆弱性存在的情况下保持健康和生活质量。这些模块采用杂志格式，包括关于每个主题的关键信息、个性化内容的电子邮件和其他手段、促进与家庭照顾者和提供者沟通的“对话启动器”，以及与当地和互联网资源的有针对性的链接等。MCC将在入组后的基线、1个月和3个月时在I-IV期乳腺癌患者中进行测试。干预组将收到MCC，注意力控制组将收到症状管理手册。这项创新的研究可以帮助建立姑息治疗作为SM干预措施的支柱，针对严重的，进行性疾病。该干预措施进一步推动了NINR提高生活质量的战略计划 通过提供实用的信息，工具和沟通策略，以减少身体和心理负担，并使知情和自信的SM的复杂问题的基础护理选择。

DESCRIPTION: Despite a proliferation of palliative care services and rapidly growing evidence that palliative care increases quality and length of life, patients remain uninformed about its nature and benefits. Palliative care is specialized medical care for patients with progressive, advanced disease that offers relief from the pain, symptoms and stress of serious illness. The purpose of this study is to test a psycho-educational intervention intended to improve patients' knowledge of palliative care and to facilitate its timely integration into self-management (SM) of their breast cancer. Our specific aims are: 1) to evaluate the effects of the intervention on breas cancer patients' knowledge of palliative care; 2) to examine preliminary effects of the intervention on patients' feelings (self-efficacy, anxiety, depression, uncertainty), and behaviors (goals of care conversations, role in SM, communication skills, management of transitions, health care utilization); and 3) to evaluate the feasibility and acceptability of the proposed protocol. An exploratory aim is to investigate the extent to which demographic and clinical factors moderate the effects of the intervention, with emphasis on differences in use and outcomes among minority participants. Our preliminary work has shown the intervention to be efficacious in improving both knowledge of palliative care and SM among patients with metastatic breast cancer. These data provide strong evidence for conducting a pilot RCT in anticipation of a large RCT under an R01 mechanism. The intervention, Managing Cancer Care: A Personal Guide (MCC), consists of seven printed modules: Managing Your Symptoms; Managing Your Care and Setting Goals; Care Options; Talking With Your Health Care Providers; Talking With Your Family and Friends; Managing Transitions; and Acting Confidently During Uncertainty. The modules teach daily SM activities that help to maintain health and quality of life in the presence of physical, psychological and social vulnerabilities. Using a magazine format, the modules include key information about each topic, worksheets and other means of personalizing content, "conversation starters" to facilitate communication with family caregivers and providers, and targeted links to local and internet resources, among other features. The MCC will be tested with patients with Stage I-IV breast cancer at baseline, one, and three months following enrollment. The intervention group will receive the MCC, and the attention-control group will receive a symptom management booklet. This innovative research can help to establish palliative care as a mainstay of SM interventions that target serious, progressive illnesses. The intervention furthers the NINR Strategic plan to promote quality of life for patients by providing practical information, tools and communication strategies to reduce physical and psychological burden, and to enable informed and confident SM of the complex issues underlying care options.