Pathway to Equity: Feasibility and Proof of Concept of Meaning-Centered Psychotherapy for Chinese Patients with Advanced Cancer

项目摘要 亚洲人是美国增长最快的种族/民族群体，也是唯一一个患癌症而不是 心脏病，是导致死亡的首要原因。最大的亚裔群体是华裔，其中许多人 外国出生(76%)和英语水平有限(48%)。在外国出生的中国人更有可能是 被诊断出癌症的时间比在美国出生的中国人要晚。许多晚期癌症患者遭受 从精神和情感上的痛苦，生命的终结，绝望和绝望，使他们的疾病复杂化 管理层。以意义为中心的心理治疗(MCP)是一种以演示为中心的人工干预 成功增强晚期癌症患者的意义，改善他们的精神幸福感和 生活质量。然而，MCP的疗效是在一项随机对照试验中进行的，试验对象是说英语的人， 主要是白人(76%)样本，没有检查干预对亚洲人作为一个群体的影响。 研究表明，为特定文化群体量身定做的适应文化的治疗方法是传统疗法的四倍 比为来自不同文化背景的参与者提供的干预更有效， 用LEP参与者的母语进行干预的效果是用英语进行干预的两倍。 这可能对中国的癌症患者特别重要，因为独特的社会文化风险因素 需要适应治疗的未经治疗的痛苦，包括对癌症的自我耻辱和与之相关的耻辱 寻求心理健康服务。针对中国患者，除了潜在的身体问题外，还有耻辱的担忧 所有癌症患者可能面临的行动和交通问题，远程医疗提供的心理健康 降低公众知名度的干预措施可能会有很大的用处。因此，迫切需要发展 为中国晚期癌症患者量身定做的、可远程访问的心理社会干预措施。 为了解决这一差距，在我们的初步工作中，我们进行了形成性研究，以评估心理社会和 中国晚期癌症患者以意义为中心的需求。这项工作导致了最初的 中国晚期癌症患者MCP干预手册(MCP-CH)的编制 简体中文和生成的用于额外查询的区域，即需要审查和完善 治疗内容与心理健康专家的意见，并确定可能影响 在未来的试验中实施远程医疗递送的MCP-CH。在本研究中，我们将(1)提纯MCP-CH 材料，以提高文化和语言的可接受性和可理解性，并评估可能 影响MCP-CH的实施，基于15名工作的精神卫生提供者的利益相关者反馈 与中国癌症患者的关系。然后我们将(2)确定可行性和初步的岗位前有效性 27例中国人III/IV期实体瘤患者远程保健MCP-CH的研究 任何类型的癌症(n=20名符合预期自然减少率的患者)。这项研究的结果将填补一个关键的空白 目前对这一庞大的、不断增长的和服务不足的群体的心理社会护理。

PROJECT ABSTRACT Asians are the fastest growing racial/ethnic group in the United States and the only group for which cancer, not heart disease, is the leading cause of death. The largest Asian subgroup is of Chinese origin, many of whom are foreign-born (76%) and limited English proficient (LEP) (48%). Foreign-born Chinese are more likely to be diagnosed with cancer at an advanced stage than U.S. born Chinese. Many advanced cancer patients suffer from spiritual and emotional distress, end-of-life despair, and hopelessness, complicating their illness management. Meaning-Centered Psychotherapy (MCP) is a manualized intervention with demonstrated success in enhancing advanced cancer patients’ sense of meaning to improve their spiritual well-being and quality of life. However, MCP’s efficacy was tested in a randomized controlled trial with an English speaking, predominantly White (76%) sample, and did not examine the impact of the intervention on Asians as a group. Studies have shown culturally adapted treatments tailored for a specific cultural group are four times more effective than interventions provided to participants from a variety of cultural backgrounds, and those conducted in LEP participants’ native language are twice as effective as interventions conducted in English. This may be especially important for Chinese cancer patients because of unique sociocultural risk factors for untreated distress that require treatment adaptation, including self-stigma about cancer and stigma associated with seeking mental health services. For Chinese patients with stigma concerns in addition to potential physical mobility and transportation issues that all cancer patients may face, telehealth-delivered mental health interventions—which reduce public visibility—may be of great utility. There is thus a critical need to develop culturally tailored, remotely accessible psychosocial interventions for Chinese patients with advanced cancer. To address this gap, in our preliminary work, we conducted formative research to assess the psychosocial and meaning-centered needs of Chinese patients with advanced cancer. This work resulted in the initial development of a 6-session MCP intervention manual for Chinese patients with advanced cancer (MCP-Ch) in Simplified Chinese and generated areas for additional inquiry, namely, the need to review and refine therapeutic content with input from mental health experts and to identify contextual factors that may affect implementation of telehealth-delivered MCP-Ch in future trials. In this study, we will (1) refine MCP-Ch materials to enhance cultural and linguistic acceptability and comprehensibility and assess factors that may affect MCP-Ch’s implementation, based on stakeholder feedback from 15 mental health providers who work with Chinese cancer patients. We will then (2) determine the feasibility and preliminary pre-post effectiveness of telehealth-delivered MCP-Ch among 27 Mandarin-speaking Chinese patients with Stage III/IV solid tumor cancers of any type (n=20 completers with expected attrition). Results from this study will fill a critical gap in current psychosocial care for this large, growing, and underserved group.