護士主導的支援表達小組干預對乳腺癌倖存者創傷後成長的影響

自我表露的四個主題可以幫助患者在創傷後成長,這種方法可以作為乳腺癌患者住院期間的心理支援技術

Abstract

Background

Post-traumatic growth induced from cancerdiagnosis and treatment could benefit the prognosis of cancer survivors, butintervention based on self-disclosure in group is limited.

Objective

Aimed to examine the effectiveness of a supportive-expressivegroup intervention on post-traumatic growth. The impact of the intervention onanxiety and depression were also explored.

Design

This randomized clinical trial enrolledpatients from June 2017 to September 2018 with a one-month follow-up. Datacollectors were blinded to patient grouping.

Setting

A single center study in Chengdu, China.

Participants

One hundred sixty-eight participants whomet the eligibility criteria were randomly assigned to the intervention group (n = 84)or control group (n = 84); 46 were excluded and 122 patientsfinished the one-month follow-up.

Methods

Participants in the intervention groupreceived nurse-led support intervention focusing on topics such as “Being aPatient”, “Interpersonal Relationships”, “Journey for Recovery”, and “Planningthe Future” while participants in the control group received health education,rehabilitation training etc. according to the nursing routine of breast cancerpatients. The intervention was designed in accordance with the diagnosis andtreatment process as well as patient needs. Participants in both groups wereevaluated three times (T1-baseline before the intervention, T2-end of theintervention, and T3-1 month follow up). Post-traumatic growth, anxietyand depression were evaluated.

Results

Participants in the intervention groupreported higher level of post-traumatic growth (p < 0.01 or0.05) and reduced anxiety and depression (p < 0.01 or 0.05and p < 0.01 or 0.05). The multilevel model indicated thatthe intervention significantly promoted post-traumatic growth (βT3 = 7.87,p < 0.05) and dimensions of relating to others (βT3 = 4.26,p < 0.001), personal strength (βT3 = 4.27,p < 0.01), appreciation of life (βT3 = 8.69,p < 0.001), and new possibilities (βT3 = 1.91,p < 0.05), anxiety (βT3 = −3.63,p < 0.001), and depression (βT3 = −2.27,p < 0.001), but had no effect on the dimension of spiritualchange. In addition, the multi-level model showed that patients with youngerages (β = −0.05~−0.52, p < 0.05–0.001),with high school and above education levels (β = 1.53~9.29, p < 0.01)and accompanied by husbands(β = −1.48~−8.51, p < 0.05)had more effective intervention and patients with religious belief had a betterspiritual change level (β = 1.86, p < 0.001).

Conclusions

These findings provide evidence for thepotential effectiveness of the nurse-led intervention on positive benefits ofpost-traumatic growth and relieved anxiety and depression for Chinese breastcancer survivors and will inform the design and development of a largerandomized controlled trial.

Clinical relevance

The supportive-expression groupintervention can be applied independently by nurses. The four themes ofself-disclosure can help patients grow after trauma, and this method can beused as a psychological support technique for breast cancer patients duringhospitalization.

摘要翻譯(僅供參考)

背景

癌症診斷和治療引起的創傷後成長可能有益於癌症倖存者的預後,但基於群體自我表露的干預是有限的。

客觀的

旨在檢查支援-表達團體干預對創傷後成長的有效性。還探討了干預對焦慮和抑鬱的影響。

設計

這項隨機臨床試驗招募了 2017 年 6 月至 2018 年 9 月的患者,並進行了為期一個月的隨訪。數據收集者對患者分組不知情。

環境

在中國成都進行的單中心研究。

參與者

168名符合資格標準的參與者被隨機分配到干預組(n  =84)或對照組(n  =84);46 例被排除,122 例患者完成了 1 個月的隨訪。

方法

干預組的參與者接受護士主導的支援干預,重點關注“做一個病人”、“人際關係”、“康復之旅”和“規劃未來”等主題,而對照組參與者接受健康教育、康復根據乳腺癌患者的護理程式進行培訓等。干預是根據診斷和治療過程以及患者的需求設計的。兩組參與者均接受 3 次評估(干預前的 T1 基線、干預結束的 T2 和 T3-1 個月的隨訪)。評估了創傷後成長、焦慮和抑鬱。

結果

干預組的參與者報告了更高水準的創傷後成長(p  < 0.01 或 0.05)以及減少的焦慮和抑鬱(p  < 0.01 或 0.05 和p  < 0.01 或 0.05)。多層次模型表明,干預顯著促進了創傷後成長(β T3  = 7.87,p  < 0.05)和與他人相關的維度(β T3  = 4.26,p  < 0.001),個人力量(β T3  = 4.27,p  < 0.01)、對生活的欣賞 ( β T3  = 8.69, p  <0.001) 和新的可能性 ( β T3 = 1.91, p  <0.05)、焦慮 ( β T3  = -3.63, p  <0.001) 和抑鬱 ( β T3  = -2.27, p  <0.001),但對靈性改變的維度沒有影響。此外,多水準模型顯示,患者年齡較小(β  =-0.05~-0.52,p  <0.05-0.001),高中及以上文化程度(β  =1.53~9.29,p  <0.01)並伴有丈夫(β  = -1.48~-8.51,p  < 0.05)干預更有效,有宗教信仰的患者有更好的精神變化水準(β  = 1.86,p  < 0.001)。

結論

這些發現為護士主導的干預對中國乳腺癌倖存者的創傷後成長和緩解焦慮和抑鬱的積極益處的潛在有效性提供了證據,並將為大型隨機對照試驗的設計和開發提供資訊。

臨床相關性

支援表達小組干預可由護士獨立應用。自我表露的四個主題可以幫助患者在創傷後成長,這種方法可以作為乳腺癌患者住院期間的心理支援技術。


THE   END

  

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