Cultural Adaptation of IMCP for Latino Patients with Advanced Cancer

描述(由申请人提供)：与非西班牙裔白人患者和其他少数族裔患者相比，拉美裔患者心理和生活质量较差的风险更高，他们通常报告使用精神和宗教策略来应对癌症。在癌症经历中保持希望、精神健康和找到意义是至关重要的 晚期癌症患者的适应和福祉。然而，对于被诊断为晚期癌症的拉丁裔患者，没有针对性的心理社会或心理治疗干预措施。以个体意义为中心的心理治疗(IMCP)是一种新型的心理治疗干预措施，旨在帮助晚期癌症患者在生命即将结束时维持或增强一种意义、宁静和使命感。Pilot随机对照试验的初步结果表明，IMCP显著减少了以非西班牙裔白人为主的晚期癌症患者的心理痛苦，显著提高了精神幸福感和生活意义和使命感。这项研究的长期目标是在语言和文化上使IMCP适应讲西班牙语的拉丁裔癌症患者。这项研究的总体目标是使用混合方法设计，以了解晚期癌症的意义、希望、遗产和身份的来源，并探索将IMCP应用于被诊断为晚期癌症的拉丁裔人的可接受性和可行性。研究结果将被用于遵循生态效度模型和文化适应过程模型的干预手册。为了实现这些目标，我们将使用两阶段收敛的混合方法设计。首先，我们将调查70名讲西班牙语的晚期癌症患者和50名为拉美裔癌症患者提供服务的精神卫生专业人员，以评估IMCP的方法、概念和目标的可接受性和可行性。只有完成调查问卷的患者才会被要求进行深入访谈，以使用融合整合的方法对信息进行三角测量。将采访15名被诊断为晚期癌症的拉丁裔患者，以了解患者在癌症诊断后的含义来源；探索他们对IMCP模式概念的理解；并帮助识别IMCP目标、概念、方法和隐喻的可接受性和可行性。这将是第一次适用于被诊断为晚期癌症的拉丁裔人的治疗干预。这项应用响应了NCI战略计划的第八个优先事项，即研究和确定造成差异的因素，开发文化上适当的方法，并传播干预措施，以克服从疾病预防到临终关怀的整个癌症控制连续过程中的健康差异。这一重大贡献将解决西班牙语人口缺乏姑息治疗癌症干预措施的问题。这项形成性研究的结果将为这一特定干预措施的适应提供指导，同时也将推动心理社会干预与医疗人群的文化适应领域。OMB编号0925-0001/0002(08/12版批准至2015年8月31日)页面续格式页面

DESCRIPTION (provided by applicant): Latinos are at higher risk of poorer psychological and quality of life outcomes when compared to non-Hispanic white patients and other minority patients and commonly report using spiritual and religious strategies to cope with cancer. Maintaining hope, spiritual well-being and finding meaning in the cancer experience is critical for the adjustment and well-being of advanced cancer patients. However, there are no targeted psychosocial or psychotherapeutic interventions available for Latino patients diagnosed with advanced cancer. Individual Meaning-Centered psychotherapy (IMCP) is a novel psychotherapeutic intervention designed to help patients with advanced cancer sustain or enhance a sense of meaning, peace and purpose as they approach the end- of-life. Preliminary findings from the pilot randomized controlled trial demonstrate both the IMCP significantly reduce psychological distress and significantly increase spiritual well-being and a sense of meaning and purpose in life in predominantly non-Hispanic white advanced cancer patients. The long term goal of this study is to linguistically and culturally adapt IMCP for Spanish-speaking Latino cancer patients. The overall objective of this study is to use a mixed-method design to gain an understanding of the sources of meaning, hope, legacy and identity in advanced cancer and to explore the acceptability and feasibility of applying IMCP to Latinos diagnosed with advanced cancer. The study findings will be used to adapt the intervention manual following the Ecological Validity Model and Cultural Adaptation Process Model. To achieve these aims, we will use a two-phased convergent mixed-method design. First, we will survey 70 Spanish-speaking advanced cancer patients and 50 mental health professionals who provide services to Latino cancer patients, to assess the acceptability and feasibility of the methods, concepts and goals of IMCP. Only patients who have completed the questionnaires will be approached for the in-depth interview to triangulate the information using a convergent integration approach. Fifteen Latino patients diagnosed with advanced cancer will be interviewed to learn patients' sources of meaning following a cancer diagnosis; explore their understanding of the concepts of the IMCP model; and to help discern the acceptability and feasibility of the goals, concepts, methods and metaphors of IMCP. This will be the first therapeutic intervention adapted for Latinos diagnosed with advanced cancer. This application is responsive to the eighth priority of the NCI Strategic Plan, to study and identify factors contributing to disparities, develop culturally appropriate approaches, and disseminate interventions to overcome health disparities across the cancer control continuum from disease prevention to end-of-life care. This significant contribution will address the critical lack of palliative cancer care interventions for the Spanish- speaking population. The results of this formative study will provide guidance to this specific intervention's adaptation, but will also advance the field of cultural adaptation of psychosocial interventions with medical populations. OMB No. 0925-0001/0002 (Rev. 08/12 Approved Through 8/31/2015) Page Continuation Format Page