REmotely-delivered Supportive Programs for Improving surgical pain and disTrEss (RESPITE)

项目摘要 改善女性急性疼痛、心理困扰和其他手术结局的管理 接受疑似妇科恶性肿瘤手术的患者将主动接触易受 形成慢性疼痛非药物干预，解决多个生物行为方面的 疼痛（例如，认知的、行为的）可能在防止向慢性疼痛转变方面最有效。瑜伽 （冥想，运动和呼吸）是一种身心干预，可以减少疼痛，心理困扰， 和睡眠障碍，并改善身体功能。瑜伽有一个潜在的优势比其他 围手术期非药物干预，因为额外的组件也支持多种 术后常规护理的目标（例如，术后早期活动，鼓励深呼吸）和 可以帮助改善其他手术管理结果（例如，功能恢复，住院时间）。因此，瑜伽 可以通过多种方式最佳地改善疼痛、心理困扰和其他手术治疗结果。 生物行为机制然而，有限的严格研究已经评估了瑜伽的协调提供， 外科护理。拟议的电子健康正念运动和呼吸（eMMB）是创新的，因为它适应 瑜伽的核心组成部分，旨在消除参与的主要障碍， 从急性疼痛到慢性疼痛。我们建议进行一项eMMB的随机对照试验， 对122名因疑似妇科疾病接受手术的妇女进行移情注意力控制（AC）。 恶性肿瘤。我们的目的是确定eMMB在改善疼痛和其他手术结果方面的疗效（目的 1），并检查eMMB对拟议的近端生物行为结果的影响（目的2）。我们还将 与关键利益相关者进行半结构化访谈（n=18-24;患者、支持者、提供者、瑜伽 教师），以评估在临床中可持续实施eMMB的障碍或促进因素 护理（目标3）。了解这些因素将为未来研究中测试的实施战略提供信息。 总之，eMMB在围手术期到达患者，并有可能预防 通过低成本干预从急性疼痛过渡到慢性疼痛。的简洁性和可访问性， 干预，以及瑜伽的日益普及，使eMMB成为未来实施的强有力的候选者。 本研究在妇科恶性肿瘤手术女性中的结果可推广至 其他外科手术，因此对减少日益增长的 受慢性疼痛影响的人群。拟议的研究与以下科学机会保持一致： 减轻国家癌症研究所强调的癌症治疗的长期影响。

PROJECT SUMMARY Improving the management of acute pain, psychological distress, and other surgical outcomes among women undergoing surgery for suspected gynecologic malignancies would proactively reach a population vulnerable to developing chronic pain. Non-pharmacological interventions that address multiple biobehavioral dimensions of pain (e.g., cognitive, behavioral) may be most effective at preventing the transition to chronic pain. Yoga (meditation, movements, and breathing) is a mind-body intervention that reduces pain, psychological distress, and sleep disturbances, and improves physical function. Yoga has a potential advantage over other perioperative non-pharmacological interventions because of additional components that also support multiple goals of postoperative usual care (e.g., early postoperative mobilization, encouraging deep breathing) and could help improve other surgical management outcomes (e.g., functional recovery, length of stay). Thus, yoga may optimally improve pain, psychological distress and other surgical management outcomes through multiple biobehavioral mechanisms. Yet, limited rigorous research has evaluated yoga delivered in coordination with surgical care. The proposed eHealth Mindful Movement and Breathing (eMMB) is innovative because it adapts the core components of yoga with the intention to remove key barriers to participation and mitigate the transition from acute to chronic pain. We propose to conduct a randomized controlled trial of eMMB compared to an empathic attention control (AC) among 122 women undergoing surgery for suspected gynecologic malignancies. We aim to determine the efficacy of eMMB for improving pain and other surgical outcomes (Aim 1), and to examine the effect of eMMB on proposed proximal biobehavioral outcomes (Aim 2). We will also conduct semi-structured interviews with key stakeholders (n=18-24; patients, champions, providers, yoga instructors) to assess factors that serve as barriers or facilitators to sustainably implementing eMMB in clinical care (Aim 3). Understanding these factors will inform implementation strategies to be tested in a future study. In summary, eMMB reaches patients during the perioperative period and has the potential to prevent the transition from acute to chronic pain with a low-cost intervention. The brevity and accessibility of the intervention, and the increasing popularity of yoga, make eMMB a strong candidate for future implementation. Results from this study in women undergoing surgery for gynecologic malignancies may be generalizable to other surgical procedures and thus have important public health implications for reducing the growing population affected by chronic pain. The proposed research is aligned with the scientific opportunity for mitigating long-term effects of cancer treatment highlighted by the National Cancer Institute.