A Decision Aid for Cancer-Surviving Adolescents

描述（由申请人提供）：药物使用可能改变癌症存活青少年的健康状况，放大放疗和化疗的后期效应，并导致肺部、心血管和肝脏异常。青少年癌症幸存者在决定是像同龄人一样从事危险行为还是听从健康专家的建议时很挣扎。2003年儿童肿瘤小组晚期效应筛查指南强调了风险行为咨询的必要性。辅助决策帮助病人做好准备，做出与他们的健康状况相关的决定。

DESCRIPTION (provided by applicant): Substance use may alter health status of cancer-surviving adolescents, amplifying late effects of radiation and chemotherapy, and resulting in pulmonary, cardiovascular, and liver abnormalities. Teen cancer survivors struggle with the decision whether to engage in risk behaviors like their peers or to follow the advice of their health professional. The 2003 Children's Oncology Group Late Effects Screening Guidelines addressed the need for risk behavior counseling. Decision aids help prepare patients to make decisions relevant to their health status. The aims of this study are to: 1) test the hypothesis that teen cancer survivors, who receive a decision aid (cognitive-behavioral skills program) to enhance decision-making skills (framed within the context of risk behaviors and their interaction with late effects of cancer treatment), will report increased quality decision making 6- and 12-months post-intervention compared with the usual care group; and 2) explore the hypothesis that teen cancer survivors, who receive the decision aid will report (a) maintained or lowered risk motivation, and (b) maintained or lowered risk behavior status (in smoking, alcohol consumption, or illicit drug use) 6- and 12-months post-intervention compared with the usual care group. This prospective, randomized clinical trial will use repeated measures at 6- and 12-months post-intervention. Three pediatric oncology clinics will participate. A computer-assisted decision aid will provide 7.5 hours contact over 12 months. 240 teen cancer survivors, ages 14-19, will be recruited. Two subgroups will be used: those who report engaging in at least one risk behavior at study entry and those who do not. Teens will be chosen by serial enrollment from the clinic schedule and randomly assigned to one of two groups (usual or enhanced care) within each subgroup. The outcome measures are: decision making, risk motivation, and risk behavior status. The decision aid will be administered during the initial visit, followed by three mailed home "e-boosters" for the computer at 2, 4, and 6 months. A telephone call will be used at 9 months to maintain contact. All follow-up will be monitored by telephone calls. All measures will be completed online at all 3 endpoints, except the cognitive scale, which will be paper format on one occasion only. Data will be collected during a semistructured interview for the initial and 12-month clinic visits. Generalized linear models will be used for data analyses.