A Multimodal Mind-Body Intervention for Fear of Recurrence among Cancer Survivors

项目摘要 K23职业发展奖将使候选人成为独立的临床研究人员 拥有完善和测试身心干预措施的专业知识，以管理对疾病复发的恐惧， 医疗患者之间的相关医疗保健参与。背景恐惧复发（FOR）是一种 有慢性病史和/或危及生命的疾病史的人所面临的常见的、高度痛苦的困难。 例如，癌症幸存者，一个不断增长的人口，报告临床升高的FOR作为一个主要的心理 关心值得注意的是，由于不适应的医疗保健参与，FOR可能导致临床结局恶化 (e.g.,避免或过度使用后续筛查）。关键是要制定循证的森林资源干预措施。 放松技巧、正念冥想、认知行为技巧和积极心理学技巧是 有希望减少癌症幸存者的FOR，但试验受到孤立测试这些技能的限制 并且在同质样本（例如，仅乳腺癌）。具体目标。拟议的研究采用 混合方法设计：（1）完善多模态身心干预（放松反应弹性 通过焦点小组的分层反馈，个人访谈， 和一个跨学科专家小组，（2）在一个试点RCT中评估其在癌症中的可行性和可接受性 生存者与升高的FOR，和（3）探讨组内，纵向模式的FOR，医疗保健 参与度及其在多个时间点的协方差。训练候选人将实现短- 通过资源丰富的机构环境和有凝聚力的培训计划实现长期目标（1）临床试验 设计，（2）混合方法和纵向数据收集和分析，以及（3）医疗保健评估 订婚除了通过研究计划正在进行的导师会议和体验式培训外， 候选人将完成有针对性的课程，教学培训和影子，目前在当地和 国家会议，并在同行评审的期刊上发表。导师制。候选人将得到支持 Elyse R. Park，PhD，MPD（初级导师），格洛丽亚Y. Yeh，MD，MPH（共同导师）， Conall O 'Cleiigh博士（共同导师），John Denninger博士，博士（顾问），Hang Lee博士（顾问）， Jeffrey Peppercorn，医学博士，公共卫生硕士（顾问）和Lynne瓦格纳，博士（顾问）。冲击与NCCIH一致 资助优先事项，拟议的研究将回答有关（1）可行性和可接受性的关键问题 身心方法难以管理的症状和（2）潜在的机制，潜在的弹性。 虽然最初的研究将集中在癌症幸存者，预计候选人的培训和研究 将有广泛的应用，以各种医疗人口挣扎与不确定性的疾病 复发通过这个K23奖项，候选人将获得申请所需的培训和初步数据 对于较大的NCCIH临床试验（例如，R 01或U 01），以确定最佳的整合和剂量的头脑- 管理FOR的身体技能和对医疗保健参与的潜在下游影响。

PROJECT SUMMARY This K23 career development award will position the candidate to become an independent clinical researcher with expertise in refining and testing mind-body interventions for managing fears of illness recurrence and associated healthcare engagement among medical patients. BACKGROUND. Fear of recurrence (FOR) is a common, highly distressing difficulty faced by individuals with a history of chronic and/or life-threatening illness. For example, cancer survivors, a growing population, report clinically-elevated FOR as a chief psychological concern. Notably, FOR may lead to worsened clinical outcomes, due to maladaptive healthcare engagement (e.g., avoidance or overuse of follow-up screenings). It is critical to develop evidence-based FOR interventions. Relaxation skills, mindfulness meditation, cognitive-behavioral skills, and positive psychology techniques are promising for reducing FOR in cancer survivors, yet trials have been limited by testing these skills in isolation and among homogenous samples (e.g., breast cancer only). SPECIFIC AIMS. The proposed studies employ mixed methods designs to: (1) refine a multimodal, mind-body intervention (Relaxation Response Resiliency Program) to target FOR among cancer survivors via tiered feedback from focus groups, individual interviews, and an interdisciplinary expert panel, (2) evaluate, in a pilot RCT, its feasibility and acceptability among cancer survivors with elevated FOR, and (3) explore within-group, longitudinal patterns of FOR, healthcare engagement, and their covariance across multiple timepoints. TRAINING. The candidate will achieve short- term goals through a resource-rich institutional environment and a cohesive training plan in (1) clinical trial design, (2) mixed methods and longitudinal data collection and analysis, and (3) evaluation of healthcare engagement. In addition to ongoing mentorship meetings and experiential training through the research plan, the candidate will complete targeted coursework, didactic trainings, and shadowing, present at local and national conferences, and publish in peer-reviewed journals. MENTORSHIP. The candidate will be supported by a stellar mentoring team: Elyse R. Park, PhD, MPD (primary mentor), Gloria Y. Yeh, MD, MPH (co-mentor), Conall O’Cleirigh, PhD (co-mentor), John Denninger, MD, PhD (consultant), Hang Lee, PhD (consultant), Jeffrey Peppercorn, MD, MPH (consultant), and Lynne Wagner, PhD (consultant). IMPACT. In line with NCCIH funding priorities, the proposed research will answer critical questions about (1) the feasibility and acceptability of mind-body approaches for hard-to-manage symptoms and (2) potential mechanisms underlying resiliency. While initial studies will focus on cancer survivors, it is anticipated that the candidate’s training and research will have broad applications to a variety of medical populations struggling with uncertainty about illness recurrence. Through this K23 award, the candidate will gain the training and preliminary data needed to apply for a larger NCCIH clinical trial (e.g., R01 or U01) to determine the optimal integration and dosage of mind- body skills for managing FOR and potential downstream effects on healthcare engagement.