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（由申请人提供）：音乐疗法是一种常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；然而，很少有研究探讨基于情境支持模型的音乐疗法干预的机制。在音乐治疗学院，我们开发并测试了积极音乐参与 (AME) 干预措施，将其确定为一种可行且可接受的干预措施，可减少因癌症治疗而住院的幼儿（3-8 岁）的情绪困扰。在急性治疗期间和他们的父母是一个普遍存在的、持续存在的问题，与身体症状困扰、生活质量和家庭功能下降有关。音乐治疗师主导的 AME 使用基于音乐的游戏和家长教育/支持（音乐播放资源包；提示表），很容易。实施，并教导父母/孩子如何治疗性地使用熟悉的活动来管理痛苦。这两组随机对照试验的目的是确定有助于先前 AME 研究中观察到的积极结果的行为、社会学和心理变量。调解员）并确定干预对象我们将检查儿童参与和亲子互动的近端中介因素以及感知家庭正常性、父母对自己在治疗期间支持孩子的能力的信心（自我效能）以及独立的父母/孩子的远端中介因素。使用音乐播放来控制住院期间的痛苦。检查： 1) AME 的近端和远端调节因子对幼儿/家长结果的影响；2) AME 对幼儿/家长困扰的调节因子；3) 探索调节和调节模型中的儿童身体症状困扰（疼痛、疲劳、恶心）。 /家长二人组 (n=184) 将按年龄分层，并随机分为 AME 或注意力控制组，每组将接受 3 次由有资格的音乐治疗师主持的 3 次 45 分钟课程；连续几天收集基线、干预后和 30 天后的数据，将使用 ANCOVA 来估计，使用 MPlus 拟合适当的中介模型，然后使用百分位数引导方法测试间接效应，以通过包括适当的测试来估计间接效应。在我们的模型中，潜在调节因素与干预指标的相互作用项将在反复住院期间检查 AME，以管理痛苦并预防幸存者中的创伤性应激症状。