Using MOST to EMPOWER: Optimizing an Emotion Regulation Intervention to Enhance Well-being Among Young Adult Cancer Survivors

项目摘要 年轻的成年癌症幸存者（YAs）是一个重要的未得到充分服务的群体， 痛苦在青年人（18-39岁）中，每年约有70，000例新的癌症诊断， 在美国，有近200万人患有癌症或被诊断患有癌症， YA. YA的五年存活率很高（>80%），YA的寿命约为35至59年 预期仍然存在，强调治疗后生存护理的重要性。YAs脸独特 由于身体、认知和心理社会发展里程碑的破坏， 与患有癌症的老年人（年龄≥40岁）相比，患有癌症的老年人和心理困扰的风险更大。 因此，YAs可以从有针对性的支持性护理干预中受益，以减少痛苦并提高 他们在治疗后的存活率方面的健康状况。 为青年人制定的心理社会干预措施很少，也很少利用电子健康模式提供 支持性护理，没有一个包括通过积极的 情绪电子卫生干预措施代表了患者参与的有希望的选择，特别是在“数字化”方面。 “如人”如人。鉴于智能手机在青年人中无处不在的性质以及他们对智能手机的偏好， 由于远程提供的干预措施，青年人中缺乏电子保健干预措施是一个错失的机会。 此外，虽然心理痛苦的有害影响是众所周知的，但很少有人关注。 专注于心理健康的好处。心理健康与更好的健康有关 结果，独特的痛苦的影响，并包括领域固有的年轻患者的重视。 我们的团队开发了一种新颖的多组分干预措施，以增强心理健康， 在艾滋病、糖尿病和乳腺癌患者中的前景。我们已经在一个 电子健康交付格式（EMPOWER：用情感加强心理结果的管理 法规），以证明可行性和可接受性。通过利用创新的方法设计， 多阶段优化策略（MOST），我们提出的研究的主要目标是优化 为YAs提供EMPOWER，并为未来的随机临床试验（RCT）做好准备。为了实现这一目标，我们建议 具体目标如下：（1）利用社会变革管理计划框架，研究五个组成部分中的哪一个有助于 对YA癌症幸存者的福祉有意义;（2）确定 福利结果的组成功效。 在测试完成后，我们将有一个全面优化的，电子健康干预，以提高心理 癌症幸存者的幸福。这种优化的干预措施将用于大型多中心RCT 而且，作为一种可扩展的干预措施，它将非常适合那些原本无法获得的YA幸存者 支持性护理干预措施，以帮助管理治疗后的痛苦和提高福祉。

PROJECT SUMMARY Young adult cancer survivors (YAs) are an important underserved group at risk for significant psychological distress. There are approximately 70,000 new diagnoses of cancer annually in YAs (ages 18-39), and currently nearly 2 million people in the United States are living with or have survived being diagnosed with cancer as a YA. Five-year survival rates of YAs are high (>80%) and YAs have approximately 35 to 59 years of life expectancy remaining, underscoring the importance of post-treatment survivorship care. YAs face unique challenges given the physical, cognitive, and psychosocial developmental milestones disrupted as a result of cancer and are at greater risk of psychological distress compared to older adults (ages ≥40) with cancer. Accordingly, YAs can benefit from targeted, supportive care interventions to decrease distress and enhance well-being as they navigate post-treatment survivorship. Few psychosocial interventions have been developed for YAs or leverage eHealth modalities to provide supportive care and none have included a focus on enhancing psychological well-being through positive emotions. eHealth interventions represent promising options for patient engagement, especially with “digital natives” such as YAs. Given the ubiquitous nature of smartphones among YAs and their preference for remotely delivered interventions, the paucity of eHealth interventions among YAs is a missed opportunity. Moreover, although the deleterious effects of psychological distress are well-known, less attention has been focused on the benefits of psychological well-being. Psychological well-being is associated with better health outcomes, unique from the influence of distress, and includes domains inherently valued by young patients. Our team has developed a novel, multicomponent intervention to enhance psychological well-being that shows promise among patients with HIV, diabetes, and breast cancer. We have piloted the intervention for YAs in an eHealth delivery format (EMPOWER: Enhancing Management of Psychological Outcomes With Emotion Regulation) to demonstrate feasibility and acceptability. By leveraging an innovative methodological design, the Multiphase Optimization Strategy (MOST), the main objective of our proposed study is to optimize EMPOWER for YAs and prepare for a future randomized clinical trial (RCT). To accomplish this, we propose the following specific aims: (1) Using a MOST framework, examine which of five components contributes meaningfully to well-being among YA cancer survivors; and (2) Identify mediators and moderators of component efficacy for well-being outcomes. Upon completion of the testing, we will have a fully optimized, eHealth intervention to enhance psychological well-being among YA cancer survivors. This optimized intervention will be primed for a large, multi-site RCT and, as a scalable intervention, it will be ideally-suited for YA survivors who would otherwise not have access to supportive care interventions to help manage post-treatment distress and enhance well-being.