Translating Psychosocial Science to Clinical Care: A Dissemination Effort to Train Psychosocial Oncology Clinicians

Transcription

1 Translating Psychosocial Science to Clinical Care: A Dissemination Effort to Train Psychosocial Oncology Clinicians June 15, 2012 Paul Greene, Ph.D. Mount Sinai School of Medicine New York, NY

2 Research Team William Redd, Ph.D. Katherine DuHamel, Ph.D. Catalina Lawsin, Ph.D. Anna Rusiewicz, Ph.D. Matthew Loscalzo, M.S.W. Karen Clark, M.S. Kim Glazier, M.A. Yeraz Markarian, M.A. Emily Dayton Luis Isola, M.D. Eileen Scigliano, M.D. Celia Grosskreutz, M.D. Esperanza Papadopoulous, M.D. Craig Moskowitz, M.D. Scott Rowley, M.D.

3 Support Funding provided by the National Cancer Institute (R01-CA03609, and R25E-CA ). Prior funding provided by the American Cancer Society (RPG PBP).

4 Overview Posttraumatic Stress Disorder (PTSD) symptomatology in Hematopoietic Stem Cell Transplant (HSCT) survivors Cognitive-Behavior Therapy (CBT) for treatment of PTSD symptoms Dissemination effort

5 Distress in Cancer Cancer patients have been found to report emotional distress between 29.6% (gyn) and 43.4% (lung) prevalence (Zabora et al., 2001). Many survivors continue to suffer physical and psychological sequellae of both illness and treatments

6 Clinical Trial of CBT Goal: to investigate whether CBT can reduce distress related to HSCT and cancer. Sample: comprised of cancer survivors who have received HSCT between one and three years prior to the study Intervention delivered via telephone

7 Study Logistics Multi-center study: Mount Sinai Medical Center (NYC) Hackensack University Medical Center (NJ) Memorial Sloan-Kettering Cancer Center (NYC)

8 Eligibility Criteria For Screening months post-hsct Age > 18 years Not currently waiting for another transplant English-speaking Working phone service Do not have substance use problem Do not have suicidal tendencies Does not exhibit signs of active psychosis

9 What is CBT-HSCT? A ten-session treatment consisting of: Psychoeducation Relaxation training Cognitive coping skills training / Cognitive restructuring Systematic Desensitization Enlistment of social support

10 Results: Distress 21.8% of participants (N= 408) met study criteria for emotional distress (DuHamel et al. Journal of Clinical Oncology, 2010) 14.2% met criteria for PTSD using the 4- cluster scoring method on the PCL-C (prevalence of PTSD in general population is 3.5% -- Kessler et al., 2005) Previously we had found that 13% of survivors met DSM criteria for PTSD (Smith et al., 1999) 10

11 Results of randomized clinical trial T-CBT group experienced fewer PTSD symptoms across all follow-ups than the control group (t(80) = 2.37, p =.02) T-CBT group was less likely to be diagnosed with PTSD at the 12-month follow-up than the control group (z = -2.06, p =.04)

12 Changes in general distress by study condition Screening Baseline 6 months 9 months 12 months T-CBT Assessment Only Control

13 Dissemination effort Needs assessment Collaboration with City of Hope Cancer Center and Memorial Sloan-Kettering Cancer Center NCI cancer education grant (R25E) to train supportive care clinicians to deliver our CBT intervention

14 Dissemination effort First five of eight planned training workshops have already been conducted in New York City and in Duarte, California Sixth workshop will be held in September 2012 in New York City

15 Post-workshop resources Consultation calls We conduct monthly consultation calls in small groups (up to 13 participants) Ongoing clinical resource offered for 6 months following the training CBT training website Discussion board Relevant research articles Clinical resources

16 Dissemination: results Interest in the first five workshops has been very high, with over 775 applications for 206 spots. (26.6% acceptance rate)

17 Participant demographics across all N = % Hispanic 76.2% Caucasian 4.9% African American 3.8% Asian 8.8% other / not reported five workshops Attendees have come from: 137 different institutions Across 37 U.S. states, Puerto Rico, Japan, & Iceland

18 Results: presentations Workshop ratings (1-5 scale, 5 = best score) Clarity of presentations = 4.41 Quality of content of presentations = 4.40 Value of presentations = 4.35 Organization of and ability to follow the material = 4.42 Subject increase of knowledge = 4.15

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20 Results: breakout sessions Breakout sessions value = 4.34 (on 0-5 scale; compiled from data across first 4 training workshops) Subjective increase of knowledge from breakout sessions = 4.21 (on 0-5 scale; compiled from data across first 4 training workshops)

21 Dissemination results: SEQ Workshops showed increased clinician confidence (self-efficacy) in their ability to apply their newly learned CBT skills from before the workshop (M = 24.69, SD = 4.26) to after the workshop (M = 26.39, SD = 3.19; p <.001). (Based on first three workshops)

22 Dissemination results: CBT knowledge Knowledge of CBT theory and techniques improved for each of the first four training cohorts from before the three-day workshops to after. (pre- mean = 20.61; post- mean = 21.05, p <.02).

23 Conclusions Posttraumatic anxiety and emotional distress are significant psychosocial problems in many cancer patients and survivors, including transplant survivors Telephone-based CBT is an efficacious treatment for posttraumatic anxiety and distress in survivors of hematopoietic stem cell transplant

24 Conclusions Psychosocial clinicians in the United States recognize the utility of CBT to treat these issues, and are motivated to receive specialized psychosocial oncology training in CBT The clinical training workshops conducted for the current project appear to have been effective in disseminating an empirically supported CBT intervention for cancer patients and survivors.

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