Facilitating Advance Care Planning Discussions Between Patients with Advanced Cancer and Their Family Caregivers Using a Resilience-Building Intervention

使用增强复原力的干预措施促进晚期癌症患者及其家庭护理人员之间的预先护理计划讨论

• 批准号: 10661890
• 负责人: Li-Ting Huang Longcoy
• 金额: $ 11.48万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10661890
• 关键词: Address; Adolescent and young adult cancer patients; Advance Care Planning; Advance Directives; Advanced Malignant Neoplasm; Affect; Anxiety; Award; Awareness; Cancer Center; Caregivers; Caring; Clinical Trials; Communication; Coping Skills; Data; Decision Aid; Decision Making; Development; Distress; Emotional; Family Caregiver; Feeling; Foundations; Future; Goals; Health Professional; Healthcare; Hospice Care; Individual; Intervention; Knowledge; Malignant Neoplasms; Medical; Mental Depression; Modeling; Online Systems; Outcome; Palliative Care; Parents; Pathway interactions; Patients; Persons; Phase; Play; Positioning Attribute; Process; Psychology; Randomized, Controlled Trials; Reaction; Research; Research Design; Risk; Role; Secure; Symptoms; Testing; Training; Transact; Treatment Efficacy; Uncertainty; acceptability and feasibility; behavior change; comparative efficacy; coping; cost; design; digital; dissemination science; emotional distress; empowerment; end of life care; experience; health goals; implementation science; improved; insight; mortality; pilot test; primary outcome; promote resilience; protective effect; quality of death; randomized, clinical trials; resilience; satisfaction; secondary outcome; skill acquisition; skills; tenure track; theories; therapy development; treatment as usual; usability; web-based intervention

Project Summary This K99/R00 Pathway to Independence Award's overall goal is to develop and assess the feasibility and preliminary efficacy of a web-based resilience-building intervention to address patients with advanced cancer and their family caregivers’ appraisals of advance care planning (ACP) and individual and dyadic coping. ACP is a process to facilitate decision-making for future medical care. By supporting individuals in understanding and sharing their values and goals, ACP can help patients meet their goals for health care treatment, decrease the emotional burden of decision-making for family caregivers, and increase satisfaction with end-of-life care and quality of death. Avoidance of ACP can delay the introduction of palliative and hospice care and risk patients receiving costly and aggressive care that not only is goal- discordant but also increases family caregivers’ anxiety and depression. The rationale for a web-based resilience-building intervention is that patients and family caregivers can be empowered to accurately appraise and use appropriate coping strategies for ACP by increasing their resilience skills. Building resilience has shown promising results in reducing cancer distress in adolescents and young adults with cancer and their parents. The proposed study is guided by the Systemic Transactional Model and utilizes a dyadic intervention approach. The training goals of the proposed study are to (1) develop expertise in dyadic study design and intervention development for people with cancer and their caregivers; (2) gain specialized knowledge in digital positive psychology interventions; (3) gain skills in leading randomized controlled trials and dissemination and implementation science; and (4) secure a tenure-track position. The Specific Aims for the K99 phase are to (1) identify the ACP deliberation process among 20 dyads of patients with advanced cancer and family caregivers and (2) conduct usability testing among 9 dyads to refine the content and design of the web-based resilience-building intervention. The Specific Aims for the R00 phase are to (1) assess the feasibility and acceptability of the web-based resilience-building intervention among patients with advanced cancer and their family caregivers through a randomized clinical trial in a cancer center setting; (2) evaluate the preliminary efficacy of the intervention compared to usual care on changes in the completion of advance directives (primary outcome) and on patient and caregiver resilience, individual and dyadic coping, anxiety, and depression (secondary outcomes); and (3) explore the dyadic effects of resilience within patients with advanced cancer and their family caregivers on individual and dyadic coping, anxiety, and depression, using the Actor-Partner Interdependence Model. The expected outcomes are identification and development of the essential components of the web-based intervention (K99 phase) and data that provides a strong foundation for further development of the intervention for R01 applications and future research (R00 phase).

项目摘要 这项K99/R00独立奖的途径的总体目标是开发和评估可行性和 基于Web的弹性建设干预措施的初步效率，以解决晚期患者 癌症及其家庭护理人员对预先护理计划（ACP）的评估以及个人和二元 应对。 ACP是一个促进未来医疗决策的过程。通过支持个人 在理解和分享其价值和目标时，ACP可以帮助患者实现其健康目标 护理治疗，减少家庭护理人员决策的情绪燃烧，并增加 对临终护理和死亡质量的满意。避免ACP会延迟引入 姑息治疗和临终关怀和风险患者接受昂贵和积极的护理，这不仅是目标 - 不一致，但也增加了家庭护理人员的动画和抑郁症。基于网络的理由 弹性建设干预措施是可以使患者和家庭护理人员有能力准确 通过提高其弹性技能来评估和使用适当的ACP应对策略。建筑 韧性已显示出有望导致减少青少年和年轻人的癌症困扰 癌症和他们的父母。拟议的研究以系统性交易模型为指导，并利用 一种二元干预方法。拟议的研究的培训目标是（1）发展专业知识 癌症患者及其护理人员的二元研究设计和干预开发； （2）增益 数字积极心理学干预方面的专业知识； （3）获得领先随机的技能 对照试验，传播和实施科学； （4）确保终身任职位置。 K99阶段的具体目的是（1）确定20个二元组的ACP审议过程 患有晚期癌症和家庭护理人员的患者以及（2）在9个二元组中进行可用性测试 完善基于Web的弹性构建干预措施的内容和设计。具体目标 R00阶段是（1）评估基于Web的弹性建设的可行性和可接受性 通过随机的晚期癌症患者及其家庭护理人员的干预 在癌症中心环境中的临床试验； （2）评估干预措施的初步效率 通常要注意完成预先指令（主要结果）和患者的变化 照顾者的韧性，个人和二元应对，动画和抑郁症（次要结果）；和 （3）探索晚期癌症患者及其家人的抗韧性影响 使用演员合作伙伴 相互依存模型。预期的结果是基本的识别和发展 基于Web的干预措施（K99阶段）的组件和数据为有力的基础 进一步开发R01应用和未来研究（R00阶段）的干预措施。