Yusufov Miryam, McHugh R Kathryn, Greer Joseph A, Dalrymple Kristy, Sannes Timothy, Braun Ilana M, Tulsky James, Pirl William
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School.
McLean Hospital, Harvard Medical School.
J Contextual Behav Sci. 2023 Apr;28:226-234. doi: 10.1016/j.jcbs.2023.04.006. Epub 2023 Apr 25.
This paper describes the iterative development of an evidence-based behavioral intervention for individuals with cancer at risk for opioid use disorder, using the National Institutes of Health Stage Model for Behavioral Intervention Development. Adult patients with cancer from an outpatient palliative care clinic at an academic cancer center, with moderate to high risk of opioid misuse, were enrolled in a treatment development study that aimed to increase psychological flexibility. In this intervention, psychological flexibility is the posited mechanism of change for reduction of opioid use disorder risk. Patients completed baseline (pre-intervention) assessments, a six-session behavioral intervention based in Acceptance and Commitment Therapy, post-intervention assessments, and a semi-structured exit interview. Ten patients with moderate to high risk of opioid misuse completed the intervention. Patients rated the intervention as highly acceptable and were generally highly satisfied. Patients reported finding the coping skills helpful (e.g., mindfulness, cognitive defusion) and reported a preference for more sessions. These treatment development efforts have implications for the development and design of acceptance- and mindfulness-based, targeted interventions for individuals with cancer, receiving palliative care and at risk for opioid use disorder. Specifically, this six-session behavioral intervention to increase psychological flexibility was acceptable to patients and ready to be studied in a pilot RCT.
本文描述了一种基于证据的行为干预措施的迭代开发过程，该干预措施针对有阿片类药物使用障碍风险的癌症患者，采用了美国国立卫生研究院行为干预开发阶段模型。来自一所学术癌症中心门诊姑息治疗诊所的成年癌症患者，存在中度至高度阿片类药物滥用风险，被纳入一项旨在提高心理灵活性的治疗开发研究。在这种干预措施中，心理灵活性被假定为降低阿片类药物使用障碍风险的改变机制。患者完成了基线（干预前）评估、基于接受与承诺疗法的六节行为干预课程、干预后评估以及一次半结构化的退出访谈。十名有中度至高度阿片类药物滥用风险的患者完成了该干预。患者对该干预给予高度认可，总体上非常满意。患者报告称发现应对技巧（如正念、认知解离）很有帮助，并表示希望增加课程节数。这些治疗开发工作对为接受姑息治疗且有阿片类药物使用障碍风险的癌症患者开发和设计基于接受和正念的针对性干预措施具有启示意义。具体而言，这种旨在提高心理灵活性的六节行为干预措施为患者所接受，可准备在一项试点随机对照试验中进行研究。
