This application, in response to RFA CA/93-14, proposes to reduce the impact of functional, psychological and social limits during recovery from bone marrow transplantation (BMT). Our broad aim is to target the dominant areas of long-term concern for BMT survivors and to intervene using skills from multiple disciplines and specialties.
The specific aims of the controlled clinical trial are to determine whether a brief, focused intervention package assists patients and families in: 1) dealing effectively with ongoing medical demands and uncertainties; 2) managing reduced stamina, emotional lability, and cognitive limitations that add stress to the recovery process; 3) maintaining family relationships through unavoidable role fluctuations; and 4) managing sexuality and hormonal changes resulting from chemotherapy and irradiation. - In this controlled clinical trial design, male and female adult patients, with a primary caregiver, will be randomly assigned to one of two groups: l.) 105 will receive standard treatment consisting of a single discharge preparation session prior to return home; Il.) 105 will receive the intervention package consisting of four 90 minute workshops in the month- prior to return home, one workshop targeted to each aim. The groups will be co-led by two facilitators from a multidisciplinary team representing psychology, oncology, nursing and psychiatry. The workshops will be reinforced with two follow-up phone calls, the first at two months after return home and the second at nine months posttransplant. Intervention patients and caregivers will be able to contact a health care professional through a telephone Resource center to discuss concerns or to request information. Assessments will include two baselines prior to randomization and intervention: the first at pretransplant, the second at one month prior to returning home. Outcome assessments will be conducted one month after returning home, and at six months, one year and two years posttransplant. We will evaluate the long term impact of these interventions with three and five year follow-up assessments completed supplemental to this project. With early intervention, we expect that maladaptive patterns will be minimized, thus facilitating more rapid and thorough recovery for survivors and their families. We hypothesize that patients who participate in the intervention group will report: 1) higher levels of physical quality of life, and less distress related to medical demands and uncertainties; 2) fewer stamina limitations or cognitive disruptions, less emotional distress, and more active coping strategies to manage limitations; 3) lower levels of family conflict, greater satisfaction with family roles, and less burden for family caregivers; 4) higher levels of sexual functioning and satisfaction for both genders and fewer postmenopausal symptoms for women. The BMT setting provides a well standardized environment in which to test interventions applicable both to the ever-increasing numbers of transplantation survivors and to other populations of cancer survivors.
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