Cancer and Aging Reflections for Elders (CARE): A Geriatric-Specific Psychotherapy for Older Adults with Cancer

老年人的癌症与衰老反思 (CARE)：针对患有癌症的老年人的老年特异性心理治疗

• 批准号: 10174886
• 负责人: Christian J Nelson
• 金额: $ 67.52万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10174886
• 关键词: Achievement; Address; Aftercare; Age; Aging; Anxiety; Area; Cancer Patient; Cancer Survivor; Caring; Cessation of life; Clergy; Clinical; Communities; Counseling; Data; Decision Making; Development; Developmental Process; Distress; Elderly; Feedback; Funding Opportunities; General Population; Geography; Goals; Healthcare; Hospitals; Individual; Information Technology; Intervention; Loneliness; Malignant Neoplasms; Mediating; Mediation; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Nurses; Oncology; Outcome; Participant; Patients; Population; Psychiatry; Psychologist; Psychotherapy; Public Health; Randomized; Reporting; Research; Risk; Rural; Rural Population; Services; Social Work; Social Workers; Social isolation; Telephone; Testing; Travel; Treatment Protocols; Underserved Population; arm; cancer care; cancer diagnosis; clinical encounter; cognitive reappraisal; community organizations; completed suicide; coping; cost effective; depressive symptoms; design; efficacy testing; high risk; improved; metropolitan; mortality; multidisciplinary; novel; peer; post intervention; primary outcome; recruit; rural area; rural residence; rural setting; screening; secondary outcome; service utilization; social; theories; therapy design; treatment adherence; treatment arm; urban dwelling; willingness; young adult

PROJECT SUMMARY By 2040, 20% of the population will be over 65. Sixty percent of cancer diagnoses and 70% of cancer deaths occur in older adults, with rural older adults at a higher risk of developing and dying from cancer than their urban peers. Additionally, 73% of cancer survivors are older adults. Depression is an important concern for older adults with cancer, as estimates of those with depressive symptoms are as high as 27%. Depression often interferes with treatment decision making and treatment adherence. In rural areas, up to 25% of older adults have a diagnosable psychiatric illness. Additionally, older adults often have subsyndromal depression, with recent population estimates of up to 40% in medically ill patients. Even the presence of mild depressive symptoms is associated with significant mortality. These individuals are at increased risk for social isolation with minimal access to mental health care despite a willingness to utilize these services. We developed a novel intervention, the Cancer and Aging: Reflections for Elders (CARE) Intervention, to treat depression and distress in older cancer patients. CARE is a manualized, five session telephone intervention which can easily be disseminated. CARE uniquely focuses on aspects of aging and cancer by: 1) integrating development theory of aging with reappraisal theory, and 2) incorporating feedback from older cancer patients. This unique tailoring is designed to help older adults negotiate age specific developmental tasks and utilize reappraisal strategies important for successful aging. As a result, CARE has the potential to be more effective than “off the shelf,” standard psychotherapeutic interventions, applied to this population. Data from the pilot RCT indicated that CARE is feasible and effective. This study tests the efficacy of the CARE intervention in a large, two arm, RCT. We will partner with the Cancer Support Community (CSC) to recruit through CSC’s local affiliates in areas with large rural populations and to deliver the interventions via telephone through the CSC-identified social workers. 476 subjects will be randomly assigned to two arms: Arm 1-the CARE Intervention and Arm 2- a Social Work and Supportive Counseling (SWSC) Intervention. Both interventions will consist of 5 sessions (45 mins) and 4 briefer booster sessions (30 mins). CARE has the potential to impact the field on both a theoretical and clinical level. Importantly, CARE was tested by phone to reach older adults who are geographically isolated and was developed so different types of professionals (e.g., master’s level psychologists, social workers, clergy, psychiatry nurses) could provide the intervention. If found to be effective, CARE could be a cost effective, easily- implemented, first-line treatment for depressive symptoms for older adults with cancer.

项目摘要 到2040年，20％的人口将超过65个。癌症诊断的60％和癌症死亡的70％ 发生在老年人中，与城市相比，老年人的发展和死亡的风险更高 同龄人。另外，有73％的癌症存活是老年人。抑郁是老年人的重要问题 癌症的估计值高达27％。抑郁经常会干扰 随着治疗决策和治疗依从性。在粗糙的地区，多达25％的老年人有 可诊断的精神病。此外，老年人通常患有亚抑郁症，最近 在医学病患者中，人口估计高达40％。即使存在轻度抑郁症状 与重大死亡率有关。这些人的社会隔离风险增加了 进入心理保健目的地愿意利用这些服务。我们开发了一种新颖的干预措施， 癌症和衰老：长老（护理）干预的反思，以治疗较老的抑郁和困扰 癌症患者。护理是一种手动的五个会话电话干预，可以轻松传播。 护理独特地关注衰老和癌症的各个方面：1）将衰老的发展理论整合到 重新评估理论和2）纳入了老年癌症患者的反馈。这种独特的剪裁设计 帮助老年人谈判特定年龄的发展任务，并利用重新评估策略对 成功的衰老。结果，护理有可能比“货架上的货架”更有效，标准 心理治疗干预措施，适用于该人群。飞行员RCT的数据表明护理是 可行和有效。这项研究测试了大型两臂RCT的护理干预措施的有效性。我们将 与癌症支持社区（CSC）合作，通过CSC的当地分支机构在大型地区招募 农村人口并通过CSC认同的社会工作者通过电话提供干预措施。 476 受试者将被随机分配给两个臂：ARM 1-护理干预和手臂2-社会工作和 支持咨询（SWSC）干预。两种干预措施将包括5次（45分钟）和4个Briefer 助推器会议（30分钟）。护理有可能在理论和临床水平上影响该领域。 重要的是，通过电话测试了护理，以接触到地理上孤立并且是 开发了不同类型的专业人士（例如，硕士级别的心理学家，社会工作者，神职人员， 精神病护士）可以提供干预。如果发现有效，护理可能是一种经济有效的，很容易 - 针对癌症老年人的抑郁症状进行了一线治疗。