Leveraging mHealth to deliver integrated pain-CBT, opioid monitoring, and self-management support for advanced cancer patients coping with chronic pain

利用移动医疗为应对慢性疼痛的晚期癌症患者提供综合疼痛 CBT、阿片类药物监测和自我管理支持

• 批准号: 10286805
• 负责人: Desiree R Azizoddin
• 金额: $ 22.16万
• 依托单位: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10286805
• 关键词: Active Learning; Address; Advanced Malignant Neoplasm; Affect; Algorithms; Analgesics; Belief; Cancer Center; Cancer Pain Management; Cancer Patient; Cancer Survivor; Caring; Cellular Phone; Chronic; Chronic Cancer Pain; Clinic; Cognitive; Cognitive Therapy; Complement; Complex; Complication; Constipation; Consumption; Data Collection; Development; Disease; Distress; Education; Elements; Emotions; Ensure; Exercise; Feedback; Fright; Future; Goals; Growth; Health Technology; Intervention; Interview; Libraries; Life; Malignant - descriptor; Malignant Neoplasms; Mediator of activation protein; Medical; Medication Management; Mental Health; Mobile Health Application; Modeling; Monitor; Moods; Multimedia; Nociception; Non-Malignant; Opioid; Outcome Study; Outpatients; Pain; Pain Research; Pain intensity; Pain management; Palliative Care; Parents; Patients; Persons; Pharmacological Treatment; Pharmacology; Pharmacotherapy; Pilot Projects; Population; Psychological Factors; Public Health; Quality of life; Randomized; Relaxation; Reporting; Schedule; Self Efficacy; Self Management; Self-Direction; Self-Examination; Series; Severities; Sleep; Social Well-Being; Stress; Structure; Surveys; Symptoms; Syndrome; Technology; Testing; Therapeutic; Time; Titrations; United States National Institutes of Health; Vulnerable Populations; acceptability and feasibility; addiction; arm; biological adaptation to stress; biopsychosocial; cancer pain; chronic pain; chronic pain management; chronic pain patient; coping; design; disability; efficacy trial; end of life; experience; improved; insight; intervention effect; laxative; mHealth; mobile computing; multidisciplinary; negative affect; novel; opioid use; pain outcome; pain perception; pain self-management; palliate; programs; psychoeducation; psychoeducational; psychologic; psychological outcomes; psychological symptom; recruit; response; retention rate; satisfaction; smartphone Application; symptom self management; telehealth; therapy design; trend; usability

Project Summary Pain affects approximately two thirds of patients with advanced cancer, with rates approaching 90% near the end-of-life. Although pharmacotherapy is vitally important to alleviating chronic cancer pain, psychological factors also substantially influence pain outcomes. Cognitive Behavioral Therapy for pain (pain-CBT) is effective for chronic cancer and non-malignant pain. Unfortunately, pain-CBT in its traditional format (60- minute, in-person sessions for 12-16 weeks) is unrealistic for advanced cancer patients. Effective biopsychosocial cancer pain management requires substantial adaptation to meet the real-life needs of advanced cancer patients and should ideally integrate with pharmacotherapy support. Given the expansive need, mobile health technology is a promising strategy to deliver and ultimately disseminate brief, pain-CBT interventions to cancer patients. Our goal is to improve advanced cancer patients' pain self-management by adapting and integrating pain-CBT into our existing mHealth program designed to support patients' pharmacologic management. Our parent intervention, STAMP (Smartphone Technology to Alleviate Malignant Pain) is a patient-facing smartphone application that supports daily symptom and opioid monitoring, and delivers tailored pain psychoeducation and advice. We have a strategic opportunity to adapt and integrate pain-CBT to create novel mHealth intervention that harmonizes psychological and medical support for advanced cancer pain. Leveraging mobile technology, we will simulate the therapeutic experience of pain-CBT by 1) presenting advanced cancer-specific, multimedia psychoeducational content, 2) developing schedules to deliver daily, brief didactics, 3) facilitating insight building via surveys and tailored feedback, & 4) stimulating active learning through gamified cognitive restructuring exercises and audio-recorded relaxations. In Aim 1: We will supplement our multi-media library of cancer pain psycho-education and adapt pain-CBT content for brief mHealth delivery specific to advanced cancer, while integrating clinician and patient (n=20) feedback throughout. In Aim 2: 25 patients with chronic pain from advanced cancer will use STAMP+CBT for 6 weeks. Findings will illuminate feasibility of app use and data collection for a larger future efficacy trial (R01), allowing for exploration of meaningful trends in pain, psychological mediators, and care utilization. If proven effective, this pain-CBT and opioid management intervention has great potential to scale and make biopsychosocial pain treatment available to a population that suffers disproportionately from chronic pain and has little access to non-pharmacologic pain management treatments.

项目概要 疼痛影响大约三分之二的晚期癌症患者，接近 90% 生命终结。尽管药物治疗对于缓解慢性癌症疼痛至关重要，但心理治疗 因素也会对疼痛结果产生重大影响。疼痛认知行为疗法（pain-CBT）是 对慢性癌症和非恶性疼痛有效。不幸的是，传统形式的疼痛 CBT（60- 分钟的面对面治疗（持续 12-16 周）对于晚期癌症患者来说是不现实的。有效的 生物心理社会癌症疼痛管理需要进行大量调整才能满足现实生活的需求 晚期癌症患者，理想情况下应与药物治疗支持相结合。鉴于广阔的 需要，移动医疗技术是一种有前途的策略，可以提供并最终传播简短的疼痛 CBT 对癌症患者的干预。 我们的目标是通过调整和整合疼痛 CBT 来改善晚期癌症患者的疼痛自我管理 纳入我们现有的旨在支持患者药物管理的移动医疗计划。我们的家长 STAMP（缓解恶性疼痛的智能手机技术）是一款面向患者的智能手机 支持日常症状和阿片类药物监测，并提供量身定制的疼痛心理教育和 建议。我们有一个战略机会来调整和整合疼痛 CBT，以创建新型移动医疗干预措施 协调对晚期癌症疼痛的心理和医疗支持。利用移动技术， 我们将通过 1) 呈现先进的癌症特异性多媒体来模拟疼痛 CBT 的治疗体验 心理教育内容，2) 制定每天提供简短教学的时间表，3) 促进洞察力 通过调查和定制反馈进行构建，4）通过游戏化认知刺激主动学习 重组练习和录音放松。目标 1：我们将补充我们的多媒体库 癌症疼痛心理教育并调整疼痛 CBT 内容，以针对高级患者进行简短的移动医疗服务 癌症，同时整合临床医生和患者 (n=20) 的反馈。目标 2：25 名慢性病患者 晚期癌症疼痛将使用 STAMP+CBT 6 周。调查结果将阐明应用程序使用的可行性 以及为未来更大规模的疗效试验（R01）收集数据，以便探索有意义的疼痛趋势， 心理中介和护理利用。如果证明有效，这种疼痛 CBT 和阿片类药物管理 干预措施具有扩大规模并为以下人群提供生物心理社会疼痛治疗的巨大潜力 不成比例地患有慢性疼痛，并且很少获得非药物疼痛治疗 治疗。