Mechanisms of Active Music Engagement to Improve Health Outcomes of Children with Cancer and Parents

积极参与音乐以改善癌症儿童及其父母的健康状况的机制

• 批准号: 9105049
• 负责人: Sheri L Robb
• 金额: $ 49.24万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-06 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9105049
• 关键词: Acute; Admission activity; Adult; Aftercare; Age; Analysis of Covariance; Arts; Attention; Behavioral; Child; Childhood; Complementary therapies; Data; Data Collection; Distal; Distress; Educational process of instructing; Emotional; Family; Fatigue; Glare; Health; Hospitalization; Hospitalized Child; Hospitals; Intervention; Interview; Knowledge; Learning; Life; Literature; Malignant Childhood Neoplasm; Malignant Neoplasms; Mediating; Mediation; Mediator of activation protein; Memory; Modeling; Morbidity - disease rate; Music; Music Therapy; Nausea; Normalcy; Outcome; Pain; Palliative Care; Parent-Child Relations; Parenting Education; Parents; Play; Population; Psychological Factors; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Reaction; Reporting; Resources; Self Efficacy; Structure; Testing; Time; Work; base; cancer therapy; childhood cancer survivor; clinically relevant; coping; emotional distress; improved; intervention effect; physical symptom; post intervention; prevent; psychologic; psychosocial; public health relevance; skills; social; stress symptom; survivorship; systematic review

 DESCRIPTION (provided by applicant): Music therapy, a frequently used arts-based therapy, has become standard palliative care in many pediatric and adult hospitals; however, few studies have examined mechanisms by which music therapy interventions work. Based on the Contextual Support Model of Music Therapy, we developed and tested the Active Music Engagement (AME) intervention, establishing it as a feasible and acceptable intervention that reduces emotional distress in young children (ages 3-8) hospitalized for cancer treatment. Emotional distress in young children with cancer during acute treatment and their parents is a prevalent, persistent problem associated with physical symptom distress and diminished quality of life and family function. The music therapist-led AME uses music-based play and parent education/support (music play resource kit; tip sheets), is easy to implement, and teaches parents/children how to therapeutically use a familiar activity to manage distress. The purpose of this two group randomized controlled trial is to identify behavioral, sociological, and psychological variables contributing to positive outcomes observed in previous AME studies (i.e., mediators) and identify for whom the intervention works (i.e., moderators). We will examine proximal mediators of child engagement and parent- child interaction and distal mediators of perceived family normalcy, parent confidence (self-efficacy) about their ability to support their child during treatment, and independent parent/child use of music play to manage distress during hospitalization. We hypothesize these factors mediate change in outcomes of child emotional distress, physical symptom distress, and quality of life; parent emotional/ traumatic distress and quality of life; and family function. Specific aims are to examine: 1) effects of proximal and distal mediators of AME on young child/parent outcomes; 2) moderators of AME on young child/parent distress; 3) explore child physical symptom distress (pain, fatigue, nausea) in mediation and moderation models. Child/parent dyads (n=184) will be stratified by age and randomized in blocks of 6 to AME or attention control; each group will receive three 45-minute sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention, and 30 days later. Mediation effects will be estimated using ANCOVA, fitting appropriate mediation models using MPlus and then testing indirect effects using the percentile bootstrap approach to estimate indirect effect. Moderation effects will be tested by including appropriate interaction terms of the potential moderator with the intervention indicator in our models. Subsequent studies will examine AME across repeated hospitalizations to manage distress and prevent traumatic stress symptoms in survivorship.

 描述（由适用提供）：音乐疗法是一种经常使用的基于艺术的疗法，已成为许多儿科和成人医院的标准姑息治疗；但是，很少有研究检查了音乐疗法干预措施起作用的机制。根据音乐疗法的上下文支持模型，我们开发并测试了主动音乐参与（AME）干预措施，确立了一种可行且可接受的干预措施，可减少幼儿（3-8岁）住院治疗的幼儿的情绪困扰。急性治疗期间癌症及其父母的幼儿情绪困扰是与身体症状困扰以及生活质量和家庭功能降低有关的普遍，持久的问题。音乐治疗师主导的AME使用基于音乐的游戏和父母教育/支持（音乐播放资源套件；提示表），易于实施，并教父母/孩子如何使用熟悉的活动来管理痛苦。这两个小组随机对照试验的目的是确定行为，社会学和心理变量，导致在先前的AME研究（即介体）中观察到的积极结果，并确定干预措施起作用（即调节器）。我们将研究儿童敬业度和亲子互动的近端调解人以及感知到的家庭正常状态的盘点调解人，父母的信心（自我效益）对他们在治疗期间抚养孩子的能力以及在住院期间对抚养孩子的能力以及独立的父母/子女的使用来管理痛苦。我们假设这些因素会改变儿童情绪困扰，身体症状困扰和生活质量的结果；父母的情感/创伤性困扰和生活质量；和家庭功能。具体目的是检查：1）AME近端和盘中介体对幼儿/父母结果的影响； 2）AME的主持人关于幼儿/父母的困扰； 3）在调解和适度模型中探索儿童身体症状困扰（疼痛，疲劳，恶心）。儿童/家长二元组（n = 184）将按年龄进行分层，并在6个块中随机分为AME或注意力控制；每个小组将连续3天与一位凭证的音乐治疗师一起进行三个45分钟的会议，并在基线，干预后和30天后收集数据。将使用ANCOVA估算中介效应，使用MPLU拟合适当的中介模型，然后使用百分位数自举方法测试间接效应以估计间接效应。通过在我们的模型中，与干预指标一起使用适当的相互作用术语来测试适度效应。随后的研究将检查反复住院的AME，以控制困扰并防止生存中的创伤性压力症状。