Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
J Pain Symptom Manage. 2021 Sep;62(3):637-646. doi: 10.1016/j.jpainsymman.2021.02.036. Epub 2021 Mar 5.
Psychosocial and supportive care interventions are a cornerstone of palliative care science, yet there is little published guidance regarding how to develop, test, adapt, and ultimately disseminate evidence-based interventions. Our objective was to describe the application of a single intervention-development model in multiple populations of patients with serious illness. Specifically, we use the "Promoting Resilience in Stress Management" (PRISM) intervention as an exemplar for how the Obesity Related Behavioral Intervention Trials (ORBIT) intervention-development model may be applied to: 1) create an initial palliative care intervention; 2) adapt an existing intervention for a new patient-population; 3) expand an existing intervention to include new content; and, 4) consider dissemination and implementation of a research-proven intervention. We began by identifying key psychological and social science theories and translating them a testable clinical hypothesis. Next, we conducted observational studies and randomized trials to design, refine, and standardize PRISM within unique patient-populations. We moved backwards in the ORBIT model when necessary to adapt or expand PRISM content and delivery-strategies to meet patient-reported needs. Finally, we began to explore PRISM's effectiveness using Dissemination and Implementation research methods. Key lessons include the need to ground intervention-development in evidence-based theory; involve patient, clinician, and other stakeholders at every phase of development; "meet patients where they are at" with flexible delivery strategies; invest in the time to find the right scientific premise and the right intervention content; and, perhaps most importantly, involve an interdisciplinary research team.
心理社会和支持性护理干预是姑息治疗科学的基石，但关于如何开发、测试、调整和最终传播基于证据的干预措施，几乎没有发表的指导意见。我们的目标是描述如何将单一干预措施开发模型应用于多个严重疾病患者群体。具体来说，我们使用“促进应激管理中的适应力”（PRISM）干预措施作为范例，说明肥胖相关行为干预试验（ORBIT）干预措施开发模型如何应用于：1）创建初始姑息治疗干预措施；2）为新的患者群体改编现有的干预措施；3）将现有的干预措施扩展到包含新内容；以及，4）考虑研究证明的干预措施的传播和实施。我们首先确定关键的心理和社会科学理论，并将其转化为可测试的临床假设。接下来，我们进行了观察性研究和随机试验，以在独特的患者群体中设计、改进和标准化 PRISM。当需要调整或扩展 PRISM 的内容和交付策略以满足患者报告的需求时，我们会在 ORBIT 模型中向后移动。最后，我们开始使用传播和实施研究方法探索 PRISM 的有效性。关键经验包括需要将干预措施的开发建立在基于证据的理论基础上；在发展的每个阶段都让患者、临床医生和其他利益相关者参与；“根据患者的实际情况”采用灵活的交付策略；投入时间寻找正确的科学前提和正确的干预内容；也许最重要的是，涉及跨学科的研究团队。
