Recovering Together after Cardiac Arrest: A dyadic mind-body intervention for emotional distress in cardiac arrest survivors and their informal caregivers

项目摘要 在这份K23提案中，我详细介绍了一项为期5年的培训计划，该计划将启动我作为独立调查员的职业生涯，专注于为心脏骤停（CA）幸存者及其家人制定和实施身心干预措施。背景资料：经历CA是持续的创伤，导致幸存者（高达61%）和他们的非正式照顾者（高达40%）的情绪困扰。与其他已建立生存计划的重症人群不同，CA幸存者-照顾者二人组（对）资源不足，没有准备好管理生存，这加剧了情绪困扰。CA后未经治疗的情绪困扰成为慢性病，并破坏临床和生活质量的结果。通过教授身心技能和提供资源来解决CA后早期的情绪困扰，可以预防慢性情绪困扰并提高生活质量。具体目标：我计划开发，完善和测试的可行性和可接受性的二元身心干预CA幸存者具有良好的神经功能恢复和他们的非正式照顾者（“恢复心脏骤停后一起;”RT-CA）。我的目标有三个：1）通过循证框架制定RT-CA（二元相互依存、应对转变框架、家庭力量脆弱性模型、复原力作为一个过程）和循证技能（来自认知行为疗法，辩证行为疗法，接受和承诺疗法，以及基于正念的减压），来自CA幸存者-照顾者二人组访谈的输入（N=~12对），焦点小组和与CA医疗利益相关者的访谈（N=16-24个利益相关者）; 2）通过开放试点完善RT-CA（N=5对）与离职面谈（反馈）和事前事后评估（初步可行性和可接受性）; 3）通过RT-CA与最低限度增强的常规对照相比的先导性随机临床试验（RCT）来测试RT-CA的可行性和可接受性（N=42对）。培训内容：我的研究目标由三个培训目标支持：1）二元干预开发的先进定性方法; 2）二元干预改进的混合方法（将离职访谈定性数据与前后评估定量数据相结合）; 3）二元身心RCT方法。我的多学科导师团队由临床健康心理学家Ana-Maria Vranceanu博士和开发和完善二元身心干预的专家领导，Michael Donnino博士和Sarah Perman博士分别是急诊医学医生和CA临床试验和CA结果研究专家。我的培训目标得到以下方面的支持：1）坚定的多学科导师，2）马萨诸塞州总医院和哈佛医学院丰富的机构环境，3）有针对性的课程，健康公平和多样性培训，研讨会和研讨会，科学会议和体验式学习。我的建议符合NCCIH的优先事项“支持互补和综合健康方法的有影响力的临床试验”。影响：我是一名临床心理学研究员，致力于提高CA生存率。这个K23是我成为一个独立资助的研究人员在改善CA和最终重症监护生存的第一步。K23将为RT-CA的未来试验铺平道路，包括适应文化多样性的二人组，没有非正式照顾者的幸存者，失去亲人的照顾者和昏迷CA幸存者的照顾者。RT-CA有可能通过提供身心技能和资源来科普生存挑战，从而为CA创造一种新的护理标准。

PROJECT SUMMARY In this K23 proposal I detail a 5-year training plan that will launch my career as an independent investigator focused on developing and implementing mind-body interventions for cardiac arrest (CA) survivors and their families. Background: Experiencing a CA is continuously traumatic resulting in emotional distress in survivors (up to 61%) and their informal caregivers (up to 40%). Unlike other critically ill populations with established survivorship programs, CA survivor-caregiver dyads (pairs) are under-resourced and unprepared to manage survivorship, which exacerbates emotional distress. Untreated emotional distress post-CA becomes chronic and undermines clinical and quality of life outcomes. Addressing emotional distress early after CA by teaching mind-body skills and providing resources may prevent chronic emotional distress and improve quality of life. Specific aims: I plan to develop, refine, and test the feasibility and acceptability of a dyadic mind-body intervention for CA survivors with good neurologic recovery and their informal caregivers (“Recovering Together after Cardiac Arrest;” RT-CA). My aims are three-fold: 1) develop RT-CA through evidence-based frameworks (dyadic interdependence, response shift framework, family strength vulnerability model, resilience as a process) and evidence-based skills (from cognitive behavior therapy, dialectical behavior therapy, acceptance and commitment therapy, and mindfulness-based stress reduction), input from interviews with CA survivor-caregiver dyads (N=~12 dyads), and focus groups and interviews with CA medical stakeholders (N=16-24 stakeholders); 2) refine RT-CA through an open pilot (N=5 dyads) with exit interviews (for feedback) and pre-post assessments (for initial feasibility and acceptability); 3) test RT-CA for feasibility and acceptability (N=42 dyads) through a pilot randomized clinical trial (RCT) of RT-CA compared to a minimally enhanced usual control. Training: My research aims are supported by three training goals: 1) advanced qualitative methods for dyadic intervention development; 2) mixed methods for dyadic intervention refinement (integrating exit interview qualitative data with pre-post assessment quantitative data); 3) dyadic mind-body RCT methodology. My multi-disciplinary mentorship team is led by Dr. Ana-Maria Vranceanu, a clinical health psychologist and expert in developing and refining dyadic-mind body interventions, and Drs. Michael Donnino and Sarah Perman, emergency medicine physicians and experts in CA clinical trials and CA outcomes research respectively. My training goals are supported by 1) committed, multi-disciplinary mentors, 2) a rich institutional environment at Massachusetts General Hospital and Harvard Medical School, and 3) targeted coursework, health equity and diversity trainings, seminars and workshops, scientific meetings, and experiential learning. My proposal is in line with the NCCIH priority of “supporting impactful clinical trials of complementary and integrative health approaches.” Impact: I am a clinical psychology fellow committed to improving CA survivorship. This K23 is my first step towards becoming an independently funded investigator in improving CA and eventually critical care survivorship. This K23 will pave the way for future trials of RT-CA, including adaptations for culturally diverse dyads, survivors without informal caregivers, bereaved caregivers, and caregivers of comatose CA survivors. RT-CA has the potential to create a new standard of care for CA by providing mind-body skills and resources to cope with survivorship challenges.