Piloting Pathways, a Hope-Enhancing Intervention to Address Activity and Role Function in Metastatic Lung Cancer Patients

项目摘要 肺癌是男性第二常见的癌症，也是导致癌症死亡的主要原因。 美国近9万名女性将被诊断为转移性非小细胞肺癌 (非小细胞肺癌)，占肺癌的40%。转移的最令人苦恼的后果之一 非小细胞肺癌对患者的影响是其对日常活动的参与和作用。占肺的40%-65% 癌症患者报告说，他们日常活动和角色的损害是一个最重要的未得到满足的支持性护理需求。 这种护理差距反映在现有的干预措施中，这些干预措施没有直接解决职能问题，而且做得不好 整合到初级肿瘤护理中。这项研究的总体目标是通过以下方式解决这一保健差距 实施支持性护理干预以帮助解决小学儿童的活动和角色功能问题 肿瘤科护理。我们的研究表明，干预患者的希望，这反映了追求的机构 目标和确定追求目标的途径，可能是解决活动和作用的一种有前途的方法 转移性非小细胞肺癌患者的功能问题。根据我们的初步数据，我们的多学科团队 已经调整了一种希望增强的干预措施，用于初级肿瘤护理中转移性非小细胞肺癌患者。 这一干预被称为路径，以希望理论为基础，包括5个旨在帮助 患者确定有意义和可行的目标，以追求和增加患者的代理和途径 在可能存在疾病障碍的情况下追求目标，包括肺癌耻辱。干预措施是 由一名接受过支持性护理培训的护士通过面对面和电话会议提供。这项研究 在本申请中提出的将评估路径的可行性。在目标1中，我们将通过 对6名转移性非小细胞肺癌患者进行试点，并与他们进行访谈，以评估其可接受性 并收集需要改进的方面的建议。我们的多学科团队将审查 来自目标1和优化路径的信息。然后，在目标2中，我们将测试可行性(患者收益， 20例转移性非小细胞肺癌患者的路径依从性、保留率、患者可接受性评分)并进行评估 术后希望的变化、癌症相关的目标干扰以及与功能和功能相关的结果测量 苦恼。这项研究的结果将确定护士提供的希望增强干预的可行性 改善转移性非小细胞肺癌患者的活动和角色功能，并提供初步数据，为 干预效果的随机对照试验。

Project Summary Lung cancer is the second most commonly diagnosed cancer and leading cause of cancer death among men and women in the U.S. Nearly 90,000 people will be diagnosed with metastatic non-small cell lung cancer (NSCLC) this year, representing 40% of lung cancers. One of the more distressing consequences of metastatic NSCLC to patients is its effect on their participation in daily activities and roles. Between 40-65% of lung cancer patients report that impairment in their daily activities and roles is a top unmet supportive care need. This care gap is reflected in existing interventions, which do not directly address function and are not well integrated into primary oncologic care. The overall goal of this research is to address this care gap by implementing a supportive care intervention to help address activity and role function concerns in primary oncologic care. Our research suggests that intervening on patient hope, which reflects agency for pursuing goals and identifying pathways to pursue goals, may be a promising approach to address activity and role function concerns in metastatic NSCLC patients. Informed by our preliminary data, our multidisciplinary team has adapted a hope-enhancing intervention for use with metastatic NSCLC patients in primary oncologic care. The intervention, called Pathways, is based in Hope Theory and comprised of 5 sessions designed to help patients identify meaningful and feasible goals to pursue and increase patient agency and pathways for pursuing goals in the presence of likely disease obstacles, including lung cancer stigma. The intervention is delivered by a nurse with training in supportive care through in-person and phone sessions. The research proposed in this application will evaluate the feasibility of Pathways. In Aim 1, we will refine Pathways by piloting it with 6 metastatic NSCLC patients and conducting interviews with them to evaluate its acceptability and gather suggestions for aspects that need to be improved. Our multidisciplinary team will review the information from Aim 1 and refine Pathways. Then, in Aim 2, we will test the feasibility (patient accrual, adherence, retention, patient acceptability ratings) of Pathways with 20 metastatic NSCLC patients and assess pre-post changes in hope, cancer-related goal interference, and outcome measures related to function and distress. Results of this study will determine the feasibility of a nurse-delivered hope-enhancing intervention to improve function in activities and roles in metastatic NSCLC patients and provide preliminary data to inform a randomized controlled trial of efficacy of the intervention.