Leveraging mHealth to deliver integrated pain-CBT, opioid monitoring, and self-management support for advanced cancer patients coping with chronic pain

利用移动医疗为应对慢性疼痛的晚期癌症患者提供综合疼痛 CBT、阿片类药物监测和自我管理支持

• 批准号: 10609388
• 负责人: Desiree R Azizoddin
• 金额: $ 15.15万
• 依托单位: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609388
• 关键词: Active Learning; Address; Advanced Malignant Neoplasm; Affect; Algorithms; Analgesics; Belief; Cancer Center; Cancer Pain Management; Cancer Patient; Caring; Cellular Phone; Chronic; Chronic Cancer Pain; Clinic; Cognitive; Cognitive Therapy; Complement; Complex; Complication; Constipation; Consumption; Data Collection; Development; Disease; Distress; Education; Elements; Emotions; Ensure; Exercise; Feedback; Fright; Future; Goals; Growth; Health Technology; Intervention; Interview; Libraries; Life; Malignant - descriptor; Malignant Neoplasms; Mediator; Medical; Medication Management; Mobile Health Application; Modeling; Monitor; Moods; Multimedia; Nociception; Non-Malignant; Opioid; Outcome Study; Outpatients; Pain; Pain Research; Pain intensity; Pain management; Palliative Care; Parents; Patients; Persons; Pharmacological Treatment; Pharmacotherapy; Pilot Projects; Population; Psychological Factors; Public Health; Quality of life; Randomized; Relaxation; Reporting; Schedule; Self Direction; Self Efficacy; Self Management; Self-Examination; Series; Severities; Sleep; Social Well-Being; Stress; Structure; Surveys; Survivors; Symptoms; Syndrome; Technology; Testing; Therapeutic; Time; Titrations; United States National Institutes of Health; Vulnerable Populations; acceptability and feasibility; addiction; arm; biological adaptation to stress; biopsychosocial; cancer pain; chronic pain; chronic pain management; chronic pain patient; coping; design; disability; efficacy trial; end of life; experience; improved; insight; intervention effect; laxative; mHealth; mobile computing; multidisciplinary; negative affect; new technology; novel; opioid use; pain outcome; pain perception; pain self-management; palliate; pharmacologic; programs; psychoeducation; psychoeducational; psychologic; psychological outcomes; psychological symptom; recruit; response; retention rate; satisfaction; smartphone application; symptom self management; telehealth; therapy design; trend; usability

Project Summary Pain affects approximately two thirds of patients with advanced cancer, with rates approaching 90% near the end-of-life. Although pharmacotherapy is vitally important to alleviating chronic cancer pain, psychological factors also substantially influence pain outcomes. Cognitive Behavioral Therapy for pain (pain-CBT) is effective for chronic cancer and non-malignant pain. Unfortunately, pain-CBT in its traditional format (60- minute, in-person sessions for 12-16 weeks) is unrealistic for advanced cancer patients. Effective biopsychosocial cancer pain management requires substantial adaptation to meet the real-life needs of advanced cancer patients and should ideally integrate with pharmacotherapy support. Given the expansive need, mobile health technology is a promising strategy to deliver and ultimately disseminate brief, pain-CBT interventions to cancer patients. Our goal is to improve advanced cancer patients' pain self-management by adapting and integrating pain-CBT into our existing mHealth program designed to support patients' pharmacologic management. Our parent intervention, STAMP (Smartphone Technology to Alleviate Malignant Pain) is a patient-facing smartphone application that supports daily symptom and opioid monitoring, and delivers tailored pain psychoeducation and advice. We have a strategic opportunity to adapt and integrate pain-CBT to create novel mHealth intervention that harmonizes psychological and medical support for advanced cancer pain. Leveraging mobile technology, we will simulate the therapeutic experience of pain-CBT by 1) presenting advanced cancer-specific, multimedia psychoeducational content, 2) developing schedules to deliver daily, brief didactics, 3) facilitating insight building via surveys and tailored feedback, & 4) stimulating active learning through gamified cognitive restructuring exercises and audio-recorded relaxations. In Aim 1: We will supplement our multi-media library of cancer pain psycho-education and adapt pain-CBT content for brief mHealth delivery specific to advanced cancer, while integrating clinician and patient (n=20) feedback throughout. In Aim 2: 25 patients with chronic pain from advanced cancer will use STAMP+CBT for 6 weeks. Findings will illuminate feasibility of app use and data collection for a larger future efficacy trial (R01), allowing for exploration of meaningful trends in pain, psychological mediators, and care utilization. If proven effective, this pain-CBT and opioid management intervention has great potential to scale and make biopsychosocial pain treatment available to a population that suffers disproportionately from chronic pain and has little access to non-pharmacologic pain management treatments.

项目摘要 疼痛影响大约三分之二的晚期癌症患者，比率接近90％ 寿命。尽管药物治疗对于缓解慢性癌症疼痛至关重要，但心理 因素也会大大影响疼痛结果。疼痛的认知行为疗法（疼痛-CBT）为 对慢性癌和非恶性疼痛有效。不幸的是，疼痛-CBT的传统格式（60-- 对于晚期癌症患者而言，分钟时间为12-16周）是不切实际的。有效的 生物心理社会癌症疼痛管理需要大量适应以满足现实生活中的需求 晚期癌症患者，理想地应与药物疗法支持相结合。给定广泛的 需求，移动健康技术是一项有前途的策略，可以交付并最终传播简短的痛苦CBT 癌症患者的干预措施。 我们的目标是通过适应和整合疼痛CBT来改善晚期癌症患者的疼痛自我管理 进入我们现有的MHealth计划，旨在支持患者的药理管理。我们的父母 干预，邮票（减轻恶性疼痛的智能手机技术）是面向患者的智能手机 支持每日症状和阿片类药物监测的应用，并提供量身定制的疼痛心理教育和 建议。我们有一个战略性的机会来适应和整合痛苦-CBT来创建新型MHealth干预措施 这协调了对晚期癌症疼痛的心理和医疗支持。利用移动技术， 我们将通过1）提出晚期癌症特异性多媒体来模拟疼痛-CBT的治疗经验 心理教育内容，2）制定日程安排，以提供每日简短教学，3）促进见解 通过调查和量身定制的反馈构建，＆4）通过游戏认知刺激积极学习 重组练习和音频录制的放松。在AIM 1中：我们将补充我们的多媒体库 癌症疼痛心理教育和适应疼痛-CBT含量，以简短的MHealth交付特定于先进 癌症，同时整合临床医生和患者（n = 20）的反馈。在AIM 2：25例慢性患者 晚期癌症的疼痛将使用邮票+CBT 6周。调查结果将阐明应用使用的可行性 和数据收集的数据收集，以进行更大的未来功效试验（R01），从而探索有意义的疼痛趋势， 心理介体和护理利用。如果被证明有效，则这种疼痛CBT和阿片类药物管理 干预具有扩展和使生物心理社会疼痛治疗可用于人群的巨大潜力 由于慢性疼痛而遭受不成比例的痛苦，几乎无法获得非药物疼痛管理 治疗。