Cancer Pain Management: A Technology-Based Intervention for Asian American Breast Cancer Survivors

癌症疼痛管理：针对亚裔美国乳腺癌幸存者的基于技术的干预措施

• 批准号: 10595357
• 负责人: Wonshik Chee
• 金额: $ 74.42万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10595357
• 关键词: Address; Adopted; Analgesics; Asian Americans; Attitude; Biological Markers; Breast Cancer Risk Factor; Breast Cancer survivor; COVID-19 pandemic; Cancer Center; Cancer Pain Management; Cancer Patient; Cancer Survivor; Chinese; Chronic; Communities; Computer software; Computers; Control Groups; Data; Devices; Dimensions; Disease; East Asian; Ethnic Origin; Family history of; Family member; Fatigue; Fright; Gatekeeping; Genetic; Goals; Health; Healthcare; Individual; Institute of Medicine (U.S.); Internet; Intervention; Intervention Studies; Japanese; Koreans; Language; Malignant Neoplasms; Measures; Mediating; Mental Depression; Methods; Modality; Oncology; Operating System; Outcome; Outcome Study; Pain; Pain management; Patient Self-Report; Pharmacology; Phase; Population; Prevalence; Process; Quality of life; Race; Randomized; Relative Risks; Reporting; Research; Running; Self Efficacy; Sleep disturbances; Stigmatization; Stoicism; Stress; Stress and Coping; Subgroup; Survival Rate; Survivors; Symptoms; Technology; Testing; Time; Translating; Translations; Work; active control; addiction; authority; base; cancer pain; chronic pain; cost effectiveness; cultural competence; depressive symptoms; design; digital; efficacy evaluation; efficacy testing; ethnic disparity; ethnic minority; evidence base; experience; flexibility; follow-up; group intervention; handheld mobile device; health care service; health care settings; health disparity; help-seeking behavior; high risk; improved; innovation; intervention effect; malignant breast neoplasm; opioid epidemic; pain symptom; phase 2 study; pilot test; primary outcome; programs; prototype; racial and ethnic; social health determinants; social influence; social stigma; survivorship; symptom management; theories; therapy development; treatment as usual; usability; web app; web server

Due to cultural stigma attached to breast cancer, cultural stoicism toward pain and symptoms, and language barriers, Asian American breast cancer survivors tend to suffer unnecessarily from pain that could be easily managed using existing pharmacologic or non-pharmacologic strategies. Especially, Asian American breast cancer survivors with depressive symptoms (ABD) are more likely to have inadequate pain management due to their depression, and pain could further deteriorate depression. Furthermore, the recent opioid crisis has exacerbated their fear of addiction and reluctance to seek help for pain management. The COVID19 pandemic has also placed an additional dimension of stress to this specific population. However, survivorship programs at cancer centers lack the staff and time to adequately address these unique needs of this population. A technology-based approach using computers and mobile devices promises to meet this necessity with high flexibility, accessibility, and anonymity. Based on Preliminary Studies (PSs), the research team developed and pilot-tested an evidence-based Web App-based information and coaching/support program for cancer pain management (CAPA) that was culturally tailored to Asian American breast cancer survivors using multiple unique features. However, CAPA rarely considered depressive symptoms accompanying pain in its design or components, and PSs indicated the necessity of further individualization of the intervention components of CAPA due to diversities in the needs of ABD. The purpose of the proposed 2-phase study is to further develop CAPA with additional components for ABD and the individual optimization functionality (CAI) and to test the efficacy of CAI in improving cancer pain experience of ABD. The specific aims are to: a) develop and evaluate CAI through an expert review and a usability test (R61 phase); b) determine whether the intervention group (that uses CAI and usual care) will show significantly greater improvements than the active control group (that uses CAPA and usual care) in primary outcomes (cancer pain management and cancer pain experience including depressive symptoms) from baseline to post 1-month and post 3-months; c) identify theory-based variables (attitudes, self-efficacy, perceived barriers, and social influences) that mediate the intervention effects of CAI on the primary outcomes; and d) determine whether the effects of CAI on the primary outcomes are moderated by selected background, disease, genetic, and situational factors. This study is guided by the Bandura’s Theory and the stress and coping framework by Lazarus and Folkman. The R61 phase includes: (a) the intervention development process, (b) a usability test among 15 ABD, 15 family members, and 15 community gatekeepers; and (c) an expert review among 10 experts in oncology. The R33 phase adopts a randomized repeated measures control group design among 300 ABD. Long-term goals are: (a) to extend and test CAI in various healthcare settings with diverse subgroups of ABD, (b) examine the cost- effectiveness, sustainability, and scalability of CAI in the settings, and (c) translate CAI into health care for ABD.

由于乳腺癌附有文化污名，对疼痛和症状的文化坚忍以及语言 障碍，亚裔美国乳腺癌的存活往往会因疼痛而遭受不必要的痛苦 使用现有的药理学或非药物策略进行了管理。特别是亚裔美国人的乳房 患有抑郁症状（ABD）的癌症存活更可能导致疼痛管理不足 抑郁症和疼痛可能会进一步恶化抑郁症。此外，最近的阿片类药物危机有 加剧了他们对成瘾和不愿为疼痛管理寻求帮助的恐惧。 Covid19大流行还为该特定人群增加了应力的额外维度。但是，癌症中心的生存计划缺乏足够的工作人员和时间来充分满足该人群的这些独特需求。使用计算机和移动设备的基于技术的方法有望以高 灵活性，可访问性和匿名性。根据初步研究（PSS），研究小组开发了， 对基于证据的基于Web应用程序的信息和癌症疼痛的教练/支持计划进行了测试 管理（CAPA）是针对亚裔美国乳腺癌存活量的文化量的（CAPA） 独特的功能。但是，CAPA很少考虑其设计伴随疼痛的抑郁症状或 组件和PSS表明进一步个性化的干预组成部分的必要性 CAPA由于ABD需求的多样性而引起的。拟议的2相研究的目的是进一步 开发具有ABD和个体优化功能（CAI）的其他组件的CAPA和 测试CAI在改善ABD癌症疼痛体验方面的效率。具体目的是：a）发展 并通过专家审查和可用性测试（R61阶段）评估CAI； b）确定是否 干预组（使用CAI和通常的护理）将显示出比活跃的更大的改进 对照组（使用CAPA和通常的护理）在主要结果（癌症疼痛管理和癌症） 从基线到1个月后和3个月后的疼痛经历，包括抑郁症状）； c）识别 基于理论的变量（态度，自我效能感，感知的障碍和社会影响） CAI对主要结果的干预影响； d）确定CAI对 主要的结果由选定的背景，疾病，遗传和情境因素调节。这项研究 Lazarus and Folkman的指导下，Bandura的理论以及压力和应对框架的指导。 R61 阶段包括：（a）干预开发过程，（b）15个ABD，15个家庭中的可用性测试 成员和15个社区守门人； （c）10位肿瘤学专家之间的专家审查。 R33 相适应300 ABD中的随机重复测量对照组设计。长期目标是： （a）在各种医疗保健环境中使用ABD的潜水员亚组扩展和测试CAI，（b）检查成本 - CAI在设置中的有效性，可持续性和可扩展性，以及（c）将CAI转化为ABD的医疗保健。