Psychosocial Impact of Pediatric Bone Marrow Transplant

儿科骨髓移植的心理社会影响

• 批准号: 6917885
• 负责人: Sean Phipps
• 金额: $ 37.1万
• 依托单位: ST. JUDE CHILDREN'S RESEARCH HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-01 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6917885
• 关键词: adolescence (12-20); alternative medicine; behavioral /social science research tag; bone marrow transplantation; clinical research; clinical trials; family structure /dynamics; human subject; human therapy evaluation; longitudinal human study; massage therapy; middle childhood (6-11); outcomes research; patient care management; patient oriented research; pediatric neoplasm /cancer; prognosis; psychological aspect of cancer; psychological models; psychological stressor; psychological tests; quality of life; social psychology; social support network

DESCRIPTION (provided by applicant): Advances in the technology and supportive care associated with bone marrow and stem cell transplantation (BMT) have led to improved medical outcomes for children with cancer and other catastrophic illnesses. However, the BMT procedure remains a prolonged, physically and emotionally demanding experience for patients and families. Our current research has demonstrated that patients experience a high level of somatic distress and associated mood disturbance during the acute phase of BMT, and further, that parental caregivers also experience a high level of emotional distress during the same procedure. Although this distress is relatively transient, research on long-term psychosocial outcomes in BMT suggests that it may be associated with later disturbances in the social functioning, self-esteem, and general emotional well-being of survivors, as well as with an increased risk of post-traumatic stress symptoms in survivors and their parents. Novel interventions to reduce the stresses of BMT are needed, but few empirical studies of psychosocial interventions during BMT have been reported, and those have involved only adult patients. The results of our pilot study testing a multi-component, health promotion intervention for patients during their BMT hospitalization indicated that two components; massage and humor therapy, were rated as significantly more helpful than the others. These findings have guided the design of this proposed randomized intervention trial. The overall aim of the proposed project is to evaluate the impact of a health promotion intervention for childrenundergoing bone marrow or stem cell transplant (BMT). The intervention is complementary in nature, designed to increase the experience of positive affect and reduce somatic distress and mood disturbance, that is, to improve overall child well being. The study will utilize a positive psychology model, exploring the hypothesis that unproved outcomes will be mediated by the increased experience of positive affect states brought about by the intervention. The primary focus is on a child-targeted intervention that includes massage therapy and humor therapy. The study will also assess whether the addition of a similar parent-targeted intervention involving massage therapy and relaxation training will provide significant benefits beyond those provided by the child-targeted intervention alone. Both child and parent interventions will include a significant education component, guided by our model of positive psychology. The study will utilize a 3-group design, with participants randomized to receive: 1) a child-targeted intervention; 2) a child targeted intervention plus a parent-targeted intervention; 3) standard care. Primary outcomes include child positive affect, somatic distress and mood disturbance, as well as measures of parental positive affect and distress. Additional objectives of the study include examining the impact of the intervention on short-term medical outcomes, as well as measures of child adjustment and parent and child post-traumatic stress symptoms (PTSS) at 6 months post-BMT. Finally, analyses will explore hypotheses specific to the positive psychology model, testing the role of positive affect and dispositional optimism as mediators and moderators of the intervention on child and parent well being.

描述（由申请人提供）：技术进步和支持 与骨髓和干细胞移植（BMT）相关的护理已导致 改善患有癌症和其他灾难性儿童的医疗结果 疾病。然而，BMT 程序仍然是一个长期的、身体上和 对患者和家属的情感要求较高的体验。我们目前的 研究表明，患者会经历高水平的躯体体验 BMT 急性期期间的痛苦和相关情绪障碍，以及 此外，父母的照顾者也会经历高度的情绪化 在同一过程中感到痛苦。虽然这种苦恼相对来说 对 BMT 中长期心理社会结果的研究表明，它是短暂的 可能与后来的社会功能障碍有关， 幸存者的自尊和总体情感健康，以及 幸存者及其家属出现创伤后应激症状的风险增加 父母。需要新的干预措施来减轻 BMT 的压力，但很少有 关于 BMT 期间心理社会干预的实证研究已有报道， 而且这些只涉及成年患者。我们的试点研究结果 在治疗期间测试患者的多成分健康促进干预措施 他们的 BMT 住院表明有两个组成部分；按摩和幽默 疗法被认为比其他疗法更有帮助。这些 研究结果指导了这项拟议的随机干预试验的设计。 拟议项目的总体目标是评估健康的影响 对接受骨髓或干细胞治疗的儿童进行促进干预 移植（BMT）。干预措施本质上是互补的，旨在 增加积极情感的体验并减少躯体痛苦和情绪 干扰，即改善儿童的整体福祉。该研究将 利用积极心理学模型，探索未经证实的假设 结果将通过积极情感状态的增加经验来调节 干预带来的。主要关注点是针对儿童 干预包括按摩疗法和幽默疗法。该研究将 还评估是否添加类似的以家长为目标的干预措施 包括按摩疗法和放松训练将提供显着的帮助 所带来的益处超出了仅针对儿童的干预措施所能提供的益处。两个都 儿童和家长的干预措施将包括重要的教育部分， 以我们的积极心理学模型为指导。该研究将采用 3 组 设计，参与者随机接受：1）针对儿童的 干涉; 2）针对儿童的干预加上针对家长的干预 干涉; 3）规范护理。主要成果包括儿童积极影响、 躯体痛苦和情绪障碍，以及父母积极的措施 影响和困扰。该研究的其他目标包括检查 干预措施对短期医疗结果的影响以及措施 儿童适应和父母与儿童创伤后应激症状（PTSS）的影响 BMT 后 6 个月。最后，分析将探讨特定于 积极心理学模型，测试积极情感和 性格乐观作为儿童干预的中介者和调节者 和父母的福祉。