Efficacy and Mechanistic Testing of a Self-Management Intervention for Managing Chronic Pain with Cancer Survivors

癌症幸存者慢性疼痛自我管理干预措施的功效和机制测试

基本信息

批准号：
9789951
负责人：
Linda H. Eaton
金额：
$ 15.27万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-21 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9789951
关键词：
Absence of pain sensation Address Adult Adverse effects Affect Anxiety Appointment Biological Biological Markers Brain Cancer Survivor Constipation Data Development Discipline of Nursing Disease Effectiveness Electroencephalogram Expectancy Fatigue Fright Goals Health Care Costs Home environment Hypnosis Intervention Interview Measurement Measures Mediating Mediation Mediator of activation protein Mental Depression Mentored Patient-Oriented Research Career Development Award Mentors Methods Music National Institute of Nursing Research No Evidence of Disease Nurses Pain Pain intensity Pain interference Pain management Participant Patient Self-Report Patient-Focused Outcomes Perception Pharmacotherapy Population Psyche structure Psychological Factors Public Health Randomized Rehabilitation therapy Research Science Scientist Sedation procedure Self Management Sleep disturbances Strategic Planning Structure Symptoms Testing Time Training Treatment outcome United States United States Dept. of Health and Human Services Work absorption active method attentional control biobehavior biomarker evaluation cancer recurrence career development chronic pain chronic painful condition control trial cost curative treatments digital efficacy trial experience hypnotic improved innovation multidisciplinary next generation non-cancer chronic pain pain reduction pain self-management patient tolerability predicting response predictive marker primary outcome programs psychologic response secondary outcome skills social symptom science symptom self management

项目摘要

PROJECT SUMMARY/ABSTRACT The proposed K23 award supports the career development of Dr. Linda Eaton into a successful nurse scientist capable of leading multidisciplinary teams in advancing symptom science. Her long-term goal is to improve patient outcomes by developing effective symptom self-management approaches and to understand the biological and psychological mechanisms for these interventions. The initial step is to establish the efficacy of a recorded hypnosis intervention (RHI) for chronic pain reduction. This K23 proposal supports this goal by providing Dr. Eaton with training in (1) team science, (2) biomarkers that predict response to pain management approaches, and (3) further research skills, including mediator-moderator analysis, to evaluate interventions. Dr. Eaton’s primary mentor, Dr. Ardith Doorenbos (nursing), and co-mentors, Dr. Margaret Heitkemper (nursing), and Dr. Mark P. Jensen (rehabilitation), provide expertise in symptom science, team science, biomarker research, and use of hypnosis for pain reduction. The proposed research addresses a critical need to develop safe and effective pain management strategies. Chronic pain affects more than a third of the nearly 16 million cancer survivors in the U.S. Symptom self-management interventions – such as hypnosis – have demonstrated efficacy for many non-cancer chronic pain conditions, seldom have adverse effects, and may be an alternative or complementary approach to pharmacotherapy. However, because of its inconvenience and cost (e.g., the need for multiple appointments with an experienced clinician), hypnosis is rarely used for chronic pain management. The RHI offers an alternative delivery method with the potential to reduce pain with cancer survivors who have completed active treatment and no longer have evidence of disease. The mechanisms of this intervention need to be identified so it can be applied with precision for chronic pain management among cancer survivors. The scientific aims of this randomized control trial will (1) evaluate the efficacy of the RHI in reducing self-reported pain intensity (primary outcome), pain interference, anxiety, depression, fatigue and sleep disturbance (secondary outcomes) at 4 weeks compared to the attention control condition (music recording); (2) examine if psychological factors (hypnotic suggestibility, mental absorption, treatment outcome expectancy, and fear of cancer recurrence) moderate the relationship between RHI and pain intensity at weeks 0, 2, and 4; (3) compare brain states as measured by qEEG in cancer survivors receiving the RHI relative to the attention control condition at weeks 0, 2, and 4; and (4) explore the mediation effects of brain states (theta activity) on pain intensity at weeks 0, 2, and 4. Structured interviews will be conducted with participants to understand facilitators and barriers related to undergoing qEEG at three time points. Findings will be used to inform a larger scale R01. The focus of this proposal is consistent with the strategic plan of the National Institute of Nursing Research to advance symptom science and support the career development of the next generation of nurse scientists.

项目摘要/摘要拟议的K23奖支持琳达·伊顿（Linda Eaton）博士的职业发展成为一名成功的护士能够领导多学科团队推进症状科学的科学家。她的长期目标是通过开发有效的症状自我管理方法来改善患者的结果并了解这些干预措施的生物学和心理机制。首先是建立记录的催眠干预（RHI）的疗效减轻了慢性疼痛。这项K23提案通过向伊顿博士提供（1）团队科学培训，（2）来支持这一目标。预测对疼痛管理方法的反应的生物标志物，以及（3）进一步的研究技能，包括调解器调节器分析，以评估干预措施。伊顿博士的主要心理Ardith Doorenbos博士（护理）和联合给予者玛格丽特·海特克珀（Margaret Heitkper）（护理）和马克·詹森（Mark P. Jensen）博士（康复）症状科学，团队科学，生物标志物研究以及催眠减轻疼痛的专业知识。拟议的研究解决了建立安全有效疼痛管理的关键需求策略。慢性疼痛影响美国症状的近1600万癌症存活中的三分之一以上自我管理干预措施（例如催眠）已经证明了许多非癌症慢性的效率疼痛状况，很少有不良影响，并且可能是一种替代或完整的方法药物治疗。但是，由于其不便和成本（例如，需要多次约会有了经验丰富的临床），催眠很少用于慢性疼痛管理。 RHI提供了替代输送方法有可能减轻已经完成活跃的癌症存活的疼痛治疗，不再有疾病的证据。需要确定这种干预的机制因此，可以将其精确地用于癌症存活中的慢性疼痛管理。科学目的这项随机对照试验将（1）评估RHI在降低自我报告的疼痛强度方面的效率（主要结果），疼痛干扰，焦虑，抑郁，疲劳和睡眠障碍（次要结果）与注意力控制条件（音乐录制）相比，第4周；（2）检查心理因素是否（催眠建议性，精神虐待，预期治疗结果以及对癌症复发的恐惧）调节在第0、2和4周的RHI与疼痛强度之间的关系；（3）将大脑状态视为通过QEEG在第0周相对于注意力控制条件的癌症存活中测量 2和4; （4）探索大脑状态（theta活性）对第0、2周的疼痛强度的介导作用和4。将与参与者进行结构化访谈，以了解与在三个时间点进行QEEG。调查结果将用于告知大规模R01。该提案的重点与国家护理研究所的战略计划一致提高症状科学并支持下一代护士科学家的职业发展。