Pathways, a Hope-Based Intervention to Support Personal Goal Pursuit, Mental Health, and Quality of Life during Advanced Lung Cancer Treatment

Pathways，一种基于希望的干预措施，支持晚期肺癌治疗期间的个人目标追求、心理健康和生活质量

• 批准号: 10736668
• 负责人: Laurie McLouth
• 金额: $ 54.76万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-25 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736668
• 关键词: Address; Adult; Advanced Malignant Neoplasm; Affect; Age; Anxiety; Attention; Behavioral Sciences; Cancer Burden; Cancer Center; Cancer Patient; Cancer Survivorship; Caregivers; Caring; Clinical; Clinical Trials; Community Clinical Oncology Program; Data; Diagnosis; Distress; Effectiveness; Effectiveness of Interventions; Family; Feedback; Friends; Future; Goals; Health Care Costs; Health Personnel; Immunotherapy; Impairment; Incidence; Infusion procedures; Intervention; Intervention Trial; Kentucky; Leisures; Life; Malignant neoplasm of lung; Mediating; Mediator; Medical; Medical Oncology; Mental Health; Methods; Mind; Mission; National Cancer Institute; Normalcy; Nurses; Occupational Therapist; Outcome; Palliative Care; Pathway interactions; Patient Care; Patients; Performance Status; Persons; Population; Poverty; Premature Mortality; Psychology; Psychosocial Assessment and Care; Public Health; Quality of life; Randomized; Reporting; Research; Resource-limited setting; Role; Rural; Social Functioning; Social Workers; Subgroup; Telephone; Testing; Thinking; Toxic effect; Treatment Efficacy; Underserved Population; Universities; Update; Work; acceptability and feasibility; anxiety symptoms; cancer care; cancer therapy; care delivery; clinical practice; community setting; depressive symptoms; design; effectiveness trial; efficacy evaluation; efficacy testing; efficacy trial; end of life; evidence base; follow-up; health related quality of life; improved; innovation; intervention delivery; intervention effect; male; novel; palliative; patient population; primary outcome; psychological distress; psychosocial; randomized trial; reduce symptoms; residence; response; routine care; satisfaction; sex; skills; social; socioeconomic disadvantage; survivorship; theories; therapy design; treatment as usual; treatment response

ABSTRACT The psychosocial care of patients with advanced lung cancer (ALC) has not kept pace with current medical treatments, creating significant gaps in care. Treatments like immunotherapy have radically changed ALC care, yielding less toxicity and unprecedented increases in 5-year survival. However, mental health and quality of life concerns persist, which must be addressed to fully realize the survival benefits of these medical advancements. To meet the needs of patients in this new treatment context, psychosocial and palliative care for ALC must shift from a predominant end-of-life framework to one of survivorship. A hope-based intervention to support patients’ goal pursuits in their family, social, work, and leisure lives is a promising approach to support mental health and quality of life in this current context. The long-term goal of this research is to improve ALC patient mental health and quality of life during cancer treatment. The overall objective in this application is to test the efficacy of a novel psychosocial intervention called “Pathways” to support personal goal pursuit during ALC treatment. The central hypothesis is that Pathways will reduce goal disruption and thereby improve mental health and quality of life during ALC treatment. The rationale for this project is that Pathways, a brief, hope-based intervention delivered primarily at the point of ALC patient care by a range of healthcare providers (e.g., nurse, occupational therapist, social worker) has demonstrated feasibility and acceptability to ALC patients, with encouraging preliminary effects on goal disruption, mental health, and quality of life outcomes. The central hypothesis will be tested through two specific aims: 1) Test the efficacy of Pathways against enhanced usual care; and 2) Evaluate goal interference and goal adjustment as mediators of intervention effects. Because ALC disproportionately affects rural, older underserved populations who have been underrepresented in psychosocial intervention trials, Aim 3 will use mixed-methods to evaluate the reach and effectiveness of the Pathways intervention among these subgroups. To accomplish these aims, 234 patients undergoing treatment for ALC at the University of Kentucky Markey Cancer Center will be randomized to Pathways or enhanced usual care, with outcomes collected, pre, post, and at follow-up. The research proposed in this application is innovative because it is testing a novel intervention with respect to intervention focus and intervention delivery at the point of ALC care. The proposed research is significant because it will determine the efficacy of an intervention that is responsive to patients’ needs in the current medical landscape for ALC and has high potential for broad dissemination into routine ALC care in both high- and low-resourced settings. Once efficacy is demonstrated, the effectiveness of the intervention will be tested in both academic and community oncology practices with other advanced cancer patient populations, significantly advancing psychosocial and palliative care in this new treatment era and ultimately having a large impact on the over 600,000 people living with advanced cancer in the U.S.

抽象的 晚期肺癌（ALC）患者的心理社会护理未能跟上当前医学的步伐 免疫疗法等治疗方法从根本上改变了 ALC 护理， 毒性较小，并且 5 年生存率得到前所未有的提高，但心理健康和生活质量却得到了提高。 担忧依然存在，必须解决这些问题才能充分实现这些医疗的生存效益 为了满足患者在新的治疗环境、心理社会和姑息治疗中的需求。 ALC 必须从主要的临终框架转变为基于希望的干预措施。 支持患者在家庭、社交、工作和休闲生活中追求目标是一种有前景的方法 在当前背景下支持心理健康和生活质量 这项研究的长期目标是 改善 ALC 患者在癌症治疗期间的心理健康和生活质量。 该应用程序的目的是测试一种名为“Pathways”的新型心理社会干预措施的功效，以支持个人 ALC 治疗期间的目标追求 核心假设是路径将减少目标干扰和 在 ALC 治疗期间改善心理健康和生活质量 该项目的基本原理是： Pathways 是一项简短的、基于希望的干预措施，主要由一系列机构在 ALC 患者护理时提供 医疗保健提供者（例如护士、职业治疗师、社会工作者）已经证明了可行性和 ALC 患者的可接受性，对目标破坏、心理健康和 中心假设将通过两个具体目标进行检验：1) 检验有效性 反对加强日常护理的途径；以及 2) 评估目标干扰和目标调整作为调节因素 因为 ALC 不成比例地影响农村、服务不足的老年人群。 在心理社会干预试验中代表性不足，目标 3 将使用混合方法来评估覆盖范围 以及这些亚组中途径干预的有效性。为了实现这些目标，234。 在肯塔基大学马基癌症中心接受 ALC 治疗的患者将被随机分组 途径或加强常规护理，并收集研究前、研究后和后续的结果。 该申请中提出的方案具有创新性，因为它正在测试一种关于干预的新颖干预措施 ALC 护理中的重点和干预措施拟议的研究意义重大，因为它将 确定在当前医疗环境下响应患者需求的干预措施的功效 用于 ALC，并且具有广泛传播到资源丰富和资源匮乏地区的 ALC 常规护理中的巨大潜力 一旦效果得到证实，干预措施的有效性将在学术和学术领域得到检验。 以及与其他晚期癌症患者群体的社区肿瘤学实践，显着推进 这个新治疗时代的心理社会和姑息治疗，并最终对过去产生巨大影响 美国有 600,000 名晚期癌症患者