A Presurgery Hypnosis Training Program for Nurse Anesthetists

描述(由申请人提供)：手术是目前治愈乳腺癌的所有治疗方法中必不可少的一部分。绝大多数女性在保乳手术后会经历非常令人厌恶的副作用，包括疼痛、恶心和疲劳。手术治疗的这些副作用的负面后果反映在多个公共卫生领域，包括这些妇女所遭受的痛苦，以及医疗机构和整个社会所承担的财政费用。 为了解决这一重要的临床和公共卫生问题，我们开发并建立了一种针对乳腺癌患者的简短、术前、心理学家管理的催眠干预的有效性。这项干预显著减少了200名乳腺癌手术患者样本中的疼痛、恶心和疲劳，并为该机构为每个患者节省了727美元的成本。这表明，如果在全国范围内对所有乳腺癌手术患者常规使用术前催眠，每年将节省超过1.4亿美元的医疗保健资金。 不幸的是，有经验支持的行为医学干预措施从研究方案跃升到标准临床护理的记录糟糕透顶。新干预措施翻译失败的常见原因是没有训练有素的人员和费用。为了促进术前催眠的常规使用，以改善患者护理，我们计划实施和评估一项新的培训计划。具体地说，根据R25E计划的宣布，我们计划培训护士麻醉师，使他们了解我们以循证方法控制症状和副作用的方法，即在我们的催眠干预中。收集成本效益数据是设计的一个重要部分，因为这些数据是促进培训方案在资助期结束后继续实施的关键，因此这些数据将为决策者提供经验证据。此外，我们会训练学术医院和公立医院的护士，因为学术方面的进步往往不能为社会带来好处。计划评估将集中在三个层面：护士对培训材料的学习，他们对催眠干预的表现，以及护士麻醉师实施的催眠干预在降低机构成本和患者术后副作用方面的有效性(使用随机临床试验设计进行评估)。 目的1：制定并实施护理麻醉师的术前催眠培训方案。 目的：从最终使用者(患者)的角度考察催眠训练项目的效果。 目的：从机构(医院)角度考察催眠培训项目的相对有效性。

DESCRIPTION (provided by applicant): Surgery is an essential part of all current treatments to cure breast cancer. The vast majority of women will experience highly aversive side effects following breast conserving surgery, including pain, nausea, and fatigue. The negative consequences of these side effects of surgical treatment are reflected in multiple public health domains including the suffering these women endure, as well as the financial costs borne by medical institutions and thereby society at large. To address this important clinical and public health problem, we developed and established the effectiveness of a brief, presurgery, psychologist-administered hypnosis intervention for breast cancer patients. This intervention significantly reduced pain, nausea and fatigue in a sample of 200 breast cancer surgical patients, and additionally resulted in a cost savings to the institution of $727 per patient. This indicates that If presurgery hypnosis were routinely used with all breast cancer surgical patients on a national basis, over $140 million health care dollars would be saved each year. Unfortunately, the track record of empirically-supported behavioral medicine interventions making the jump from research protocol to standard clinical care is abysmal. Common reasons given for the failure of the translation of new interventions are the unavailability of trained personnel and cost. To promote the routine use of presurgery hypnosis to improve patient care, we plan to implement and evaluate a new training program. Specifically, consistent with the R25E program announcement, we plan to train nurse anesthetists in our evidence-based approach to symptom and side effect control, namely in our hypnosis intervention. Collecting cost-effectiveness data is an important part of the design, as such data are key to promoting the continuation of the training program beyond conclusion of the funding period, and as such data will provide empirical evidence to decision makers. Furthermore we will train nurses in both academic and public hospitals, as too often advances at academic settings do not translate to the community. Program evaluation will focus on three levels: nurses' learning of the training material, their performance of the hypnosis intervention, and the effectiveness of the nurse anesthetist-administered hypnosis intervention in reducing institutional costs and patients' postsurgery side effects (assessed using a randomized clinical trial design). Aim 1: To develop and implement a training program in presurgery hypnosis for nurse anesthetists. Aim 2: To examine the effectiveness of the presurgery hypnosis training program from the perspective of end-users (patients). Aim 3: To investigate the relative effectiveness of the hypnosis training program from the perspective of the institution (hospitals).