Pathway to Equity: Feasibility and Proof of Concept of Meaning-Centered Psychotherapy for Chinese Patients with Advanced Cancer

通往公平之路：对中国晚期癌症患者进行以意义为中心的心理治疗的可行性和概念证明

• 批准号: 10673022
• 负责人: Florence Lui
• 金额: $ 8.85万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10673022
• 关键词: Address; Adherence; Advanced Development; Advanced Malignant Neoplasm; Affect; American Association of Cancer Research; Anxiety; Area; Asian; Asian population; Behavioral Model; Cancer Intervention; Cancer Patient; Cause of Death; Chinese; Chinese population; Clinical Trials; Communities; Cultural Backgrounds; Development; Diagnosis; Distress; Effectiveness; Equity; Ethnic Origin; Ethnic Population; Face; Feedback; Feeling hopeless; Fright; Future; Goals; Health Personnel; Health Services; Intervention; Interview; Language; Life; Limited English Proficiency; Linguistics; Malignant Neoplasms; Manuals; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; New York City; Participant; Pathway interactions; Patient Participation; Patients; Personal Satisfaction; Persons; Population; Practical Robust Implementation and Sustainability Model; Provider; Psychosocial Assessment and Care; Psychotherapy; Quality of life; Race; Randomized, Controlled Trials; Recommendation; Research; Risk Factors; Sampling; Solid Neoplasm; Speech; Spirituality; Structure; Subgroup; Supervision; Surveys; Testing; Therapeutic; Transportation; Uncertainty; Underserved Population; United States; Work; advanced disease; anticancer research; arm; cancer risk; community engaged research; contextual factors; effective intervention; emotional distress; end of life; evidence base; health literacy; implementation determinants; improved; individualized medicine; innovation; internalized stigma; minority patient; mortality; novel; post intervention; primary outcome; psychological distress; psychosocial; racial population; recruit; secondary outcome; service programs; social culture; social stigma; success; telehealth; therapy design; therapy development

PROJECT ABSTRACT Asians are the fastest growing racial/ethnic group in the United States and the only group for which cancer, not heart disease, is the leading cause of death. The largest Asian subgroup is of Chinese origin, many of whom are foreign-born (76%) and limited English proficient (LEP) (48%). Foreign-born Chinese are more likely to be diagnosed with cancer at an advanced stage than U.S. born Chinese. Many advanced cancer patients suffer from spiritual and emotional distress, end-of-life despair, and hopelessness, complicating their illness management. Meaning-Centered Psychotherapy (MCP) is a manualized intervention with demonstrated success in enhancing advanced cancer patients’ sense of meaning to improve their spiritual well-being and quality of life. However, MCP’s efficacy was tested in a randomized controlled trial with an English speaking, predominantly White (76%) sample, and did not examine the impact of the intervention on Asians as a group. Studies have shown culturally adapted treatments tailored for a specific cultural group are four times more effective than interventions provided to participants from a variety of cultural backgrounds, and those conducted in LEP participants’ native language are twice as effective as interventions conducted in English. This may be especially important for Chinese cancer patients because of unique sociocultural risk factors for untreated distress that require treatment adaptation, including self-stigma about cancer and stigma associated with seeking mental health services. For Chinese patients with stigma concerns in addition to potential physical mobility and transportation issues that all cancer patients may face, telehealth-delivered mental health interventions—which reduce public visibility—may be of great utility. There is thus a critical need to develop culturally tailored, remotely accessible psychosocial interventions for Chinese patients with advanced cancer. To address this gap, in our preliminary work, we conducted formative research to assess the psychosocial and meaning-centered needs of Chinese patients with advanced cancer. This work resulted in the initial development of a 6-session MCP intervention manual for Chinese patients with advanced cancer (MCP-Ch) in Simplified Chinese and generated areas for additional inquiry, namely, the need to review and refine therapeutic content with input from mental health experts and to identify contextual factors that may affect implementation of telehealth-delivered MCP-Ch in future trials. In this study, we will (1) refine MCP-Ch materials to enhance cultural and linguistic acceptability and comprehensibility and assess factors that may affect MCP-Ch’s implementation, based on stakeholder feedback from 15 mental health providers who work with Chinese cancer patients. We will then (2) determine the feasibility and preliminary pre-post effectiveness of telehealth-delivered MCP-Ch among 27 Mandarin-speaking Chinese patients with Stage III/IV solid tumor cancers of any type (n=20 completers with expected attrition). Results from this study will fill a critical gap in current psychosocial care for this large, growing, and underserved group.

项目摘要 亚洲人是美国增长最快的种族/种族，也是唯一的癌症群体，而不是 心脏病是死亡的主要原因。最大的亚洲亚组是中国血统，其中许多 是外国出生（76％）和有限的英语熟练（LEP）（48％）。外国出生的中国人更有可能 比美国出生的中国人在高级阶段被诊断出患有癌症。许多晚期癌症患者受苦 从精神和情感困扰，临终后绝望和绝望，使他们的疾病变得复杂 管理。以意义为中心的心理治疗（MCP）是一项手动干预措施 在增强高级癌症患者的意义方面的成功，以改善其精神健康和 生活质量。但是，MCP的效率在一项随机对照试验中进行了测试， 主要是白色样本（76％），并且没有检查干预对亚洲人的影响。 研究表明，针对特定文化群体量身定制的文化适应治疗是四倍 比提供来自各种文化背景的参与者提供的干预措施， 用LEP参与者的母语进行的，是英语进行干预措施的两倍。 由于独特的社会文化风险因素，这对于中国癌症患者尤其重要 需要适应治疗的未经治疗的困扰，包括有关癌症和与污名相关的自我污名 寻求心理健康服务。除潜在的物理外，还具有污名问题的中国患者 所有癌症患者可能会面临的流动性和运输问题，远程医疗保健的心理健康 干预措施（降低了公众的知名度）可能是非常实用的。因此，有迫切需要发展 针对中国晚期癌症患者的文化量身定制的，远程访问的社会心理干预措施。 为了解决这一差距，在我们的初步工作中，我们进行了形成性研究，以评估心理心理和 中国晚期癌症患者的意义需求。这项工作导致了最初的 为中国晚期癌症患者（MCP-CH）开发6份MCP干预手册 简化中文和生成的区域，以进行其他查询，即需要审查和完善 治疗内容与心理健康专家的意见，并确定可能影响的上下文因素 在以后的试验中实施远程医疗保留的MCP-CH。在这项研究中，我们将（1）完善MCP-CH 增强文化和语言可接受性以及可理解性和评估因素的材料 基于15位精神卫生提供者的利益相关者反馈，影响MCP-CH的实施 与中国癌症患者。然后，我们将（2）确定可行性和初步前效力 在27位讲普通话的中国患者III/IV期实体瘤患者中，远程医疗保留的MCP-CH 任何类型的癌症（n = 20个具有预期属性的完成者）。这项研究的结果将填补关键的空白 当前针对这个大型，增长且服务不足的群体的心理心理护理。