Dialectical Behavioral Therapy Skills Training for Metastatic Lung Cancer Patients

转移性肺癌患者经历明显更大的心理痛苦(即，抑郁， 焦虑症)与其他癌症相比。心理困扰是临床病情恶化的一个预测指标。 癌症患者的预后和较差的总存活率。由于他们历史上预后不佳，患者 转移性肺癌通常被排除在心理社会干预方案之外。现有的干预措施做到了 没有解决导致这些患者心理痛苦加剧的因素，包括管理 高身体症状负担(疲劳、呼吸困难、疼痛)，调节挑战性情绪(羞愧、内疚、恐惧)， 以及容忍对未来的不确定性。辩证行为疗法(DBT)是一种跨诊断的证据- 以心理治疗为基础，向参与者传授一套核心的行为技能(承受痛苦、情绪 调节、正念、人际效能)，以更有效地处理情绪和身体问题 症状。DBT技能培训已适应于各种临床人群，并已证明 在减轻心理痛苦方面的功效。到目前为止，DBT技能培训还没有在患有 转移性肺癌，他们将受益匪浅。我们预计DBT技能培训将需要 适用于提高转移性肺癌患者的可接受性和相关性，包括1)分娩， 2)剂量；3)材料。这项拟议的研究旨在为患有糖尿病的患者调整和试行DBT技能培训 使用Adapt-ITT框架的转移性肺癌。参与者将是转移性肺癌患者 世卫组织在NCCN遇险温度计上得了3分。第一阶段的目标是利用焦点小组和Key的访谈 利益相关者(转移性肺癌患者(N=20)，胸部肿瘤提供者(N=6)，临床医生 生存和行为症状管理方面的专业知识(N=6)，以确定DBT技能是否和如何 必须修改培训，以便在转移性肺癌患者中实施。改编的材料将是 由DBT和实施科学方面的专题专家审查。据推测，这些活动将 为转移性肺癌患者制定一份经过调整的手工DBT技能培训方案(DBT-MLC)。 第二阶段旨在试行测试DBT-MLC，以评估可行性、可接受性，并检查干预前后 结果。假设参与者将报告主要(心理苦恼，即， 抑郁和焦虑)和次要结果测量(疲劳、呼吸困难、疼痛、情绪调节、 对不确定性的容忍，DBT应对技能的使用)。该项目符合国家癌症研究所的优先事项 癌症生存研究领域，并涉及循证干预的创新适应 没有得到充分服务的癌症人群。积极的发现将迅速为下一步的研究提供信息，进行 一项2b期随机疗效试验，比较DBT-MLC与对照条件。这项工作有可能 减少转移性肺癌患者的心理痛苦，提高临床转归。前景看好 结果可能会鼓励未来适应其他疾病类型和生存阶段。

Metastatic lung cancer patients experience significantly greater psychological distress (i.e., depression, anxiety) compared to other cancers. Psychological distress is as a prognostic indicator for worse clinical outcomes and poorer overall survival in cancer patients. Due to their historically poor prognosis, patients with metastatic lung cancer are often excluded from psychosocial intervention protocols. Existing interventions do not address factors that contribute to elevated psychological distress in these patients, including managing high physical symptom burden (fatigue, dyspnea, pain), regulating challenging emotions (shame, guilt, fear), and tolerating uncertainty about the future. Dialectical behavioral therapy (DBT) is a transdiagnostic, evidence- based psychotherapy that teaches participants a core set of behavioral skills (distress tolerance, emotion regulation, mindfulness, interpersonal effectiveness) to cope more effectively with emotional and physical symptoms. DBT skills training has been adapted for a variety of clinical populations and has demonstrated efficacy in reducing psychological distress. To date, DBT skills training has not been evaluated in patients with metastatic lung cancer, who stand to benefit immensely. We anticipate DBT skills training will need to be adapted to increase acceptability and relevance in patients with metastatic lung cancer, including 1) delivery, 2) dose, and 3) materials. The proposed study seeks to adapt and pilot test DBT skills training for patients with metastatic lung cancer using the ADAPT-ITT framework. Participants will be metastatic lung cancer patients who score >3 on the NCCN distress thermometer. Phase I aims to use focus groups and interviews with key stakeholders (metastatic lung cancer patients (N=20), thoracic oncology providers (N=6), clinicians with expertise in survivorship and behavioral symptom management (N=6)) to determine if and how DBT skills training must be modified for implementation with metastatic lung cancer patients. Adapted material will be reviewed by topical experts in DBT and implementation science. It is hypothesized that these activities will produce a manualized, adapted DBT skills training protocol for metastatic lung cancer patients (DBT-MLC). Phase II aims to pilot test DBT-MLC to assess feasibility, acceptability, and examine pre-to-post intervention outcomes. It is hypothesized that participants will report improvement on primary (psychological distress, i.e., depression and anxiety) and secondary outcome measures (fatigue, dyspnea, pain, emotion regulation, tolerance of uncertainty, DBT coping skill use). This project meets the National Cancer Institute's priority research area of cancer survivorship, and involves innovative adaptation of an evidence-based intervention for an underserved cancer population. Positive findings would rapidly inform the next step of research, conducting a phase 2b randomized efficacy trial comparing DBT-MLC to a control condition. This work has the potential to reduce psychological distress and enhance clinical outcomes in metastatic lung cancer patients. Promising results may encourage future adaptation for other disease types and stages of survivorship.